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Table of Contents
CASE REPORT
Year : 2019  |  Volume : 2  |  Issue : 1  |  Page : 48-52

Chinese guqin music and calligraphy for treating symptoms of primary insomnia


1 Department of Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
2 Department of Psychology, University of Hong Kong, HKSAR, China
3 Department of Psychology and Geography, University of Hong Kong, HKSAR, China

Date of Web Publication18-Mar-2019

Correspondence Address:
Dr. Miranda M Y Fung
China Academy of Chinese Medical Sciences, Beijing
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CMAC.CMAC_15_19

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  Abstract 


Purpose: To investigate the intervention effects of using traditional Chinese Guqin music and Chinese Calligraphy handwriting (CCH) for patients with Primary Insomnia. Methods: A total of ninety patients were assigned to control group, Guqin group, and calligraphy group for 8 weeks. For 5 days a week, patients' heart rate variability (HRV) and frontal midline (FZ) electroencephalographic signals were recorded in a clinic during interventional period while either listening to Guqin music or writing calligraphy. Patients in the control group remained in rest condition. Results: For the Guqin group, the higher low-frequency-range HRV of coherence was found with marginal significance (P = 0.055), and heart rate was significantly reduced (P < 0.05) during the 4th week in listening to Guqin music compared to the prerest period. For listening to Guqin music or calligraphy intervention, FZ δ, FZ θ, and FZ α waves in the 8th week compared to the 0th week (Pre Intervention) showed a significantly enhanced effect (P < 0.05). Between the three groups, for heart rate and FZ δ and FZ θ waves, calligraphy group showed significantly increased heart rate than the Guqin group (P < 0.001)and the control group (P = 0.004); increased FZ δ wave than the Guqin group (P < 0.001) and the control group (P < 0.001); and increased FZ θ wave than the Guqin group (P = 0.024) and the control group (P = 0.008) respectively. Conclusion: Positive intervention effects on HRV coherence of Guqin music; FZ δ, FZ θ, and FZ α waves of Guqin music and calligraphy proved that Guqin music together with calligraphy training helping to promote physical and mental health, thereby it contributes to the clinical application of TCM Psychology for patients with insomnia syndrome.

Keywords: Alpha, calligraphy, Chinese calligraphy handwriting, delta, EEG brainwave, Guqin, heart rate variability, physical and mental health, primary insomnia, TCM Psychology, theta


How to cite this article:
Fung MM, Kao HS, Lam SP, Kao TT. Chinese guqin music and calligraphy for treating symptoms of primary insomnia. Chin Med Cult 2019;2:48-52

How to cite this URL:
Fung MM, Kao HS, Lam SP, Kao TT. Chinese guqin music and calligraphy for treating symptoms of primary insomnia. Chin Med Cult [serial online] 2019 [cited 2019 Apr 19];2:48-52. Available from: http://www.cmaconweb.org/text.asp?2019/2/1/48/254377






  Introduction Top


Traditional Chinese Medicine (TCM) has always emphasized the harmony of “Essence (精), Qi (气), and Spirit (神)” and the unity between mind and body. The key to good health is the self-regulation of mind and body to reach a state of balance. We found that Guqin music and calligraphy on mental health of TCM are inextricably linked, as they both focus on “breathing exercise (运气), cultivating the heart (养心), and empathizing empathy (移情). They encompass the same key philosophy as the reinforcing method “tranquil the mind for cultivating the heart (静神养心).”

As early as in Yue Ji (《乐记》 The Record of Music), Guqin has been promoted as a means of cultivating the heart[1] in ancient China. Calligraphy therapy has recently been promoted in the field of evidence-based behavioral medicine;[15],[17],[21] in Western psychology, Guqin music and calligraphy therapy could be categorized as psychological relaxation therapy;[2] listening to Guqin music often and practicing Guqin as well as calligraphy could induce an individual state of mental peace, harmony, and health.[3],[27]


  Music Therapy on Insomnia Research Top


Music therapy is considered a traditional treatment method in physical therapy, sports therapy, and rehabilitation, which are also an integral part of the treatment methods in alternative medicine. Although drug treatment of insomnia is most common, the benefits of music therapy are confirmed with clinical efficacy: music therapy has effects on nutrition and the circulatory, respiratory, and endocrine systems. It is also confirmed in the field of psychology that music therapy effectively reduces mental symptoms of patients on anxiety and depression and sleep disorders, helps in pain relief, and improves self-appraisal.[4] Clinical research found that music therapy was effective in reducing anxiety and improving sleep quality among patients with critical illnesses.[5],[6] Relaxing music was effective for emotion regulation and treatment for patients with schizophrenia and students with depression[7] for improving the sleep quality among students and the elderly.[8],[9],[10] However, Western and TCM in academic field have no clinical reports on Guqin music or calligraphy for the intervention of patients with primary insomnia on the effect of mind–body harmony and optimal brain functions. Thus, an empirical study researching the use of calligraphy in promoting the mind–body health of patients with insomnia on heart rate variability (HRV) and frontal midline (FZ) electroencephalographic (EEG) is initiated as follows.


  Guqin and Calligraphy on Electroencephalographic Research Top


The effects of music from different cultural environments (Guqin: Chinese music; piano: Western music) on crossmodal selective attention were studied on behavioral and event-related potential (ERP) responses, with a visual task, from Chinese participants in three conditions: silence, Guqin music, or piano music background. The early (N1) and late (P300) stages exhibited no differences between Guqin and piano backgrounds during the visual task, which was in contrast with the results of the auditory task collected in previous research showing that the musical cultural factor is more obvious in intramodal than in crossmodal selective attention.[11],[12] Zhou Chang et al.[13] assigned an experimental group of 14 to do painting creation after listening to Guqin music and found that cognitive effect and creativity on brain electric spectrum analysis had greater promoting effect than that of piano music.

An early study on Chinese calligraphy handwriting (CCH) found that, when a participant reads a Chinese or English character right before writing, the English character elicited a higher positive ERP on the parietal cortex, whereas Chinese character elicited higher positive ERP on the motor cortex. It was also found that when participants started writing, both the Chinese and English characters elicited higher negative ERP on the left hemisphere, showing a process of brain activation on calligraphy writing.[14] Recently, an electroencephalographic (EEG) research on the FZ of 24 college students with theta and alpha waves of both the calligraphy group and the calligraphy with neuro-feedback group showed significant increase after 10-day intervention, reflecting a relaxed and concentrated state evoked by calligraphy.[15]


  Guqin and Calligraphy on Heart Rate Variability Top


HRV is a common index used to represent the emotional mind–body harmony phases in physiological coherence which describes a mode that encompasses entertainment, resonance, and synchronization – distinct but related phenomena, all of which emerge from the harmonious interactions of the body subsystems. Correlates of physiological coherence include increased synchronization between the two branches of the autonomic nervous system (ANS), a shift in autonomic balance toward increased parasympathetic activity, increased heart–brain synchronization, increased vascular resonance, and entrainment between diverse physiological oscillatory systems. The coherent mode is reflected by a smooth, sine wave-like pattern in the heart rhythms (heart rhythm coherence) and a narrow-band, high-amplitude peak in the low-frequency (LF) range of the HRV power spectrum, at a frequency of about 0.1 Hz.[16]

Lam et al.[17] used a smartphone and a Bluetooth chest heart rate device as a Guqin–calligraphy biofeedback system for brain health and emotion. Training results showed that the first and third Guqin sessions elicited 55% and 68%, respectively, and the second calligraphy session elicited 31% of high HRV coherence. This indicated a preliminary observation that finger calligraphy and Guqin music listening both improved one's emotion regulation, and that this effect could mean a shortening of intervention duration as well as an application of both treatments. The second session with finger writing of calligraphy further demonstrated a brain activation elicitation of 31% high and 69% medium HRV coherence ratios, showing that the heart and brain were interacting under a balanced state. We believe that this practice contributed to increased emotion regulation from 55% to 68% of high HRV coherence through an increase in attention and concentration that are associated with the practice of calligraphy.

Calligraphy therapy in evidence-based behavioral medicine can be divided into two major directions, “mind–body” and “brain”

“Mind–body” direction

In the psychology of Chinese calligraphy, Kao[18] reported a series of psychological experiments in calligraphy behavior research, mainly covering the topics of the psychological and physiological responses of calligraphic acts, such as heart rate, blood pressure, breathing, electromyography, and brainwaves (electrocardiography). Moreover, it aimed to establish a scientific foundation for calligraphy from various aspects in theory, research, and clinical application with the goal of clarifying why calligraphy, a seemingly simple writing operation, can serve as an effective treatment and result in positive overall outcomes on physical and mental health.[19],[20],[21]

“Brain” direction

From calligraphy on intelligence and brain function tests, Chinese character cognition, Chinese character structure, and attention allocation research results, a theory of “calligraphy-optimizing brain activation effect” was proposed which revealed that calligraphy can enhance the intelligence functions of the brain.[22]

Recent research has confirmed that neuroplasticity is elicited by CCH which is believed to induce significant therapeutic effects.[28] It has also confirmed that CCH therapy can reduce neuropsychiatric symptoms.[29],[30]


  Guqin and Calligraphy for “heart Cultivation” and “brain Cultivation” in Clinical Research Top


Research objective

Based on the results of the above studies, it was found that Guqin music and calligraphy are effective for “heart cultivation,” “brain cultivation,” and HRV. Delta, theta, and alpha brainwaves were measured for indexing of the present heart–brain intervention research for patients with primary insomnia.

Research method

Observation of clients: Patients were screened to meet the standards of primary insomnia. Measurements and clinical interventions took place at Yi-Ren Clinic, a specialist insomnia outpatient TCM Health Center in Hong Kong.

Group standards, exclusion criteria, and methods

Criteria

(1) Males or females aged between 16 and 70 years; (2) those who met the diagnostic criteria for insomnia in accordance with the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition and with difficulties falling asleep and/or sleeping with difficulties or feeling tired even after sleep, lasting for at least 1 month causing significant distress or damage on social, occupational, or other important features; (3) those with a lasting course with more than 4 weeks and <1 year; (4) and those with education attainment above junior high school, on a voluntary basis, and signed informed consent form.

Exclusion criteria

Individuals with mental disorder, somatic diseases, as well as other medical problems such as alcohol or drug-induced insomnia were excluded. A total of ninety cases with primary insomnia were assigned in random, with thirty to each of the three groups as control group, Guqin music group, and calligraphy group.

Clients and research procedure

Clients

A total of ninety patients with primary insomnia syndrome were assigned to control group (rest condition) (n = 30), Guqin group (n = 30), and calligraphy group (n = 29, 1 miss). They were assigned based on randomly generated numbers. Consecutive interventions lasted for 8 weeks, 5 days a week. Participants were assigned to either listening to Guqin music or tracing Chinese calligraphy characters with brush for 30 min before sleep. HRV and FZ EEG signals were recorded in a clinic on the 0th, 4th, and 8th weeks for a total of three times each week: during the pre- and post-interventional period for 3 min at rest, the 30-min interventional period either listening to Guqin music or writing calligraphy, and when the control patients remained on rest condition. Five types of Guqin music with leisure rhythms, namely (1) “Serene Orchids” 《幽兰》; (2) “Enjoyable Night-An Opening Tune”《良宵引》; (3) “Wild Geese Hovering over the Sands”《落雁平沙》; (4) “A Chat Between a Fishman and a Woodcutter”《鱼樵问答》; and (5) “Thinking of an Old Friend”《忆故人》were played with a stereo headphone by the Guqin group. A set of specially designed psychological symbols and characters by Professor Henry Kao (高尚仁)[21] from the patented biofeedback-based system of calligraphy were printed in the form of copybook for the participants of the calligraphy group to trace on the top with a calligraphy brush to complete the daily intervention.

Research equipment

ProCom 2 manufactured by Thought Technology Ltd, 5250 rue Ferrier, Suite 812, Montreal, Quebec, Canada, H4P 1L3 was employed for HRV and EEG brainwave recording. According to the standard procedure as suggested in the handbook, blood volume pulse from the index finger for heart rate and LF range (0.04 − 0.15 Hz) HRV in percentage and FZ point delta (δ), theta (θ), and alpha (α) EEG brainwaves were taken. The recorded data were preliminary analyzed using the BioGraph Infiniti version 5.1.4 system software provided by Though Technology Ltd in operation with the ProCom 2.

Statistical analysis by SPSS

Preliminary experimental data were collected from the clients by the ProCom 2 on LF-HRV, heart rate, FZ δ wave , FZ θ wave, and FZ α wave and were arranged in the following SPSS format: GROUP (control, calligraphy, Guqin music) × client measurement (0-week preintervention, 0-week intervention, 0-week postintervention; 4-week preintervention, 4-week intervention, 4-week postintervention; and 8-week preintervention, 8-week intervention, 8-week postintervention). Analysis was performed using ANOVA of the SPSS statistical software version 16.0 and general linear model with repeated measure on a 3 (between group design) × 9 (within participant design). Analysis of variance with F and P values, between groups, repeated measure of participants, and pairwise comparisons were tested with least significant difference (LSD) t-test. A P value of less than 0.05 indicates statistical significance.


  Results Top


Guqin music group for heart rate variability measure on mild body effect

Compared to preintervention, during the 4th week, LF HRV increased with marginal significance F (1, 29) = 4.000, P = 0.055 [Figure 1], and heart rate decreased significantly F (1, 29) = 4.207, P = 0.049 [Figure 2].
Figure 1: Low-frequency heart rate variability increased with marginal significant (Guqin group)

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Figure 2: Heart rate decreased significantly (Guqin group)

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For electroencephalographic measure on brain effect

  • During intervention in listening to Guqin music, the 8th week compared with the 0th week, increased significant effects were elicited on FZ δ wave F (1, 29) =11.292, P = 0.002; FZ θ wave F (1, 29) =19.005, P < 0.001, and FZ α wave F (1, 29) =8.553, P = 0.007 [Figure 3]
  • During intervention in writing calligraphy, the 8th week compared with the 0th week, increased significant effects were elicited on FZ δ wave F (1, 28) =8.551, P = 0.007; FZ θ wave F (1, 28) =10.150, P = 0.004, and FZ α wave F (1, 28) =7.686, P = 0.01 [Figure 4].
Figure 3: δ wave, θ wave, and α waves increased significantly (Guqin group)

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Figure 4: δ wave, θ wave, and α waves increased significantly (calligraphy group)

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Comparison of control group, Guqin group, and calligraphy group

  • For groups comparison on heart rate, there is a significant main effect between the calligraphy group, the Guqin group and the control group F (2, 86) = 7.419, P = 0.001; where the heart rate of the calligraphy group increased significantly higher than the Guqin group F (1, 57) = 12.291, P < 0.001 and also increased significantly higher than the control group F (1, 57) = 9.662, P = 0.004 [Figure 5]
  • For groups comparison on FZ δ wave, there is a significant main effect between the calligraphy group, the Guqin group and the control group F (2, 86) = 28.948, P < 0.001; where the FZ δ wave of the calligraphy group increased significantly higher than the Guqin group F (1, 57) = 32.252, P < 0.001 and also increased significantly higher than the control group F (1, 57) = 45.262, P < 0.001 [Figure 6]
  • For Groups comparison on FZ θ wave, there is a significant main effect between the calligraphy group, the Guqin group and the control group F (2, 86) = 4.285, P = 0.017; where the FZ θ wave of the calligraphy group increased significantly higher than the Guqin group F (1, 57) = 5.611, P = 0.024 and also increased significantly higher than the control group F (1, 57) = 7.049, P = 0.008 [Figure 7].
Figure 5: Heart rate increased significantly (calligraphy group to Guqin group and control group)

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Figure 6: δ wave increased significantly (calligraphy group compared with Guqin group and control group)

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Figure 7: θ wave increased significantly (calligraphy group compared with Guqin group and control group)

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  Discussion Top


From HRV measures for the Guqin group, we found that, during listening to Guqin music in the 4th week compared with preintervention, the LF HRV increased with marginal significance, showing a deeper heart rate coherence with positive emotion,[16] whereas the reduced heart rate demonstrated a state of relaxation.

Alpha waves occurred mostly when eyes were closed, indicating a quiet and relaxed state; thus, listening to Guqin music with increased alpha waves enhanced psychosomatic relaxation. Theta waves occurred mostly in deep relaxation, light sleep, or meditative state of consciousness; thus, listening to Guqin music results in enhanced theta waves, facilitating greater attention and cognitive processing and stimulating creativity. Delta waves mostly occurred in dreamless deep sleep and unconscious state; thus, listening to Guqin music with enhanced FZ δ wave shows a role in promoting physical and psychological recovery.[26],[27]

Similarly, during writing calligraphy, FZ δ wave, FZ θ wave, and FZ α wave were also elicited with enhanced effect on brain functions. For comparing the three group effects, heart rate reduced significantly for the Guqin group than that of the calligraphy group which showed that listening to Guqin music is more effective than writing calligraphy in inducing a deeper state of relaxation and coherence.[7] It was also found that calligraphy group experienced significantly enhanced FZ θ and FZ δ waves, which shows that, compared to the Guqin music, calligraphy enhanced FZ θ waves more efficiently in promoting comprehension and stimulating creativity, whereas enhanced FZ δ waves promote better physical and psychological recovery.[15],[26],[27]

In a study on EEG and HRV of insomnia, results revealed that HRV were significantly higher in NREM compared with those in REM for normal participants. In EEG, the normal participants had stronger delta wave power at NREM stage, but both HRV and delta wave power showed no significant differences in insomnia cases.[23]

Another study found that, even in the absence of modifications in HRV, the link between changes in cardiac autonomic activity and delta power is altered among patients suffering from chronic primary insomnia.[24],[25] The above research studies support the current study that Guqin music and calligraphy both have high efficacy on the heart and brain functions, demonstrating positive effects on primary insomnia intervention.


  Conclusion Top


Comprehensive experiments on Guqin music and calligraphy have shown that Guqin music is not only a musical instrument, but also a health-enhancing training system. More importantly, while listening to the Guqin music, the HRV shows a balancing effect of the ANS. Therefore, Guqin music is effective in inducing heart rhythm coherence in the cultivation of positive psychological well-being.

Calligraphy can bring mind–body harmony and optimize brain functions, which mean that Guqin music together with calligraphy training can help promote physical and mental health in patients with insomnia. This study has shown that Guqin music and calligraphy therapy positively contribute to the clinical applications of the TCM psychology.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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