Original Article J Sasang Constitut Med 2016;28(1):40-50 http://dx.doi.org/10.7730/jscm.2016.28.1.40 호흡시호기및흡기비율과자세가체질별심박변이도에미치는영향 김지환ㆍ배효상ㆍ박성식 동국대학교한의과대학사상체질과 Abstract The Effects of Ratio of Inhalation and Exhalation and Posture on Heart Rate Variability according to Sasang Constitution Ji-Hwan Kim, Hyo-Sang Bae, Seong-Sik Park Department of Sasang Constitutional Medicine, Dongguk University Objectives We observed what effects both ratio of inhalation and exhalation(i/e) and posture have on heart rate variability(hrv) according to Sasang Constitution(SC). Methods HRV of 73 healthy participants who filled in self-questionnaires was recorded while they carried out 0.1Hz paced breathing(pb) with sitting, usual breathing(ub) with standing, and 0.1Hz PB with standing. PB was conducted to 4:6 or 6:4 of I/E and UB with sitting was executed before and after each breathing. Finally, HRV indices were analyzed of 60 participants(soeum: 24, Soyang: 18, Taeeum: 18). Results & Conclusions In both self-questionnaires and HRV indices, there are not statistically significant between SC about the posture and I/E. SOEUM preferred 4:6 of I/E and showed lower mean RR and SDNN. SOYANG preferred 6:4 of I/E and showed higher mean RR and lower mean heart rate. TAEUM did not prefer I/E and showed the highest SDNN. Key Words : Heart rate Variability, Inhalation, Exhalation, Posture, Sasang Constitution. Received February 25, 2016 Revised February 25, 2016 Accepted March 21, 2016 Corresponding Author Seong-Sik Park Dept. of Sasang Constitutional Medicine, Bundang Korean Medical Hospital of Dongguk University, 268, Buljeong-ro, Bundang-gu, Seongnam-si, 13601, Korea Tel: +82-31-710-3723 Fax: +82-31-710-3780 E-mail: parss@dongguk.ac.kr C The Society of Sasang Constitutional Medicine. All rights reserved. This is an open acess article distributed under the terms of the Creative Commons attribution Non-commercial License (http:// creativecommons.org/licenses/by-nc/3.0/)
JH Kim et al. 41 Ⅰ. 緖論 악해보았다. 호흡은중요한양생법중하나로도가의태식 ( 胎息 ) 법과유가의조식 ( 調息 ) 법은호흡조절을통해인체의기 ( 氣 ) 흐름을원활히하기위해행해지며 1 불가의안반수의 ( 安般守意 ) 는흡기와호기에의식을집중하여깨달음을추구하기위해행해진다 2. 인도의요가에서는호흡법이요가수트라 8단계중 4단계에해당하며이때의호흡은흡기- 호기- 호흡중지의세부적조절로명상의고위단계에도달하게하는역할을한다 3. 그러므로최근에는의식적인호흡조절이건강에미치는영향이연구되고있으며 4 한의학에서도치료수단으로서호흡법의가능성이모색되고있다 5,6. 사상의학 ( 四象醫學 ) 에서는비 ( 脾 ) 와신 ( 腎 ) 을수곡 ( 水穀 ) 이출납 ( 出納 ) 하는부고 ( 府庫 ) 로보았으며또한폐 ( 肺 ) 와간 ( 肝 ) 을기액 ( 氣液 ) 이호흡 ( 呼吸 ) 하는문호 ( 門戶 ) 로보았으므로 7, 현대적인의미로사상체질적요소에영양의섭취와배출뿐만아니라수분및호흡대사의관점이접목될수있다. 하지만양생적인호흡법에체질적의미를고려한연구는현재까지드물며, 수식관 ( 數息觀 ) 호흡시체질별로심박변이도 (Heart rate variability; HRV) 가어떤차이를보이는지에관한결과가보고된적이있을뿐이다 8. 호흡은호흡빈도, 일회호흡량, 흡기와호기의비율등의조합으로구성되며 9 의식적으로흉복강의근육을움직여이러한호흡의양상을변화시킴으로써간접적으로심박수나혈압등을조절할수있다 10. 심박변화에대한측정은보통안정된좌위에서행해지지만현실적으로요가와같은명상법은다양한자세에서이루어지므로호흡의양상뿐만아니라의식적호흡을수행하는자세에따라서도생리적인변화가나타날수있다. 그러므로우리는좌위나입위의자세에서 0.1Hz 의호흡수 ( 분당 6회호흡 ) 에서흡기와호기의비율을 4초대 6초 ( 호장호흡 ), 6초대 4초 ( 흡장호흡 ) 을행할때각사상인의심박변이도에어떠한차이가나타나는지를살펴보았으며동시에체질별로느끼는주관적인신체의편안함정도를 10점만점척도로파 Ⅱ. 硏究對象및方法 1. 연구대상동국대학교에재학중인건강한젊은남녀총 73명 ( 남 37명, 여 36명, 평균나이 26.05±6.04) 이모집되었다. 모든참가자는실험에대한충분한설명을듣고서면동의서를작성하였으며자발적인의사에의해실험에참여하였다. 모든피험자는실험참여이전에호흡수련등을접한적이없으며호흡기계, 심혈관계, 자율신경계의이상을포함한질병은없었다. 참가자들은공복상태에서실험에참가하였으며실험전 12 시간이내에커피와같은생리적인변화를야기할수있는물질이나약물을복용하지않았다. 사상체질은 QSCCII(Questionnaire of Sasang Constitution Classification II), 체형측정, SCAT2(Sasang Constitution Analysis Tool) 의자료수집후사상체질전문의 1인의최종판정으로결정되었다. 73명중 7명은개인적인사정으로실험을완료하지못하고탈락하였으며 4명은심박변이도수치의통계처리중이상값이나타나데이터상에서제외되었다. 2명은사상체질판정이완료되지못했으므로최종적으로총 60명 ( 남 31명, 여 29명 ; 소음인 24명, 소양인 18명, 태음인 18명, 태양인 0명 ) 을대상으로결과를분석하였다. 2. 연구방법실험은오전 9시에서 11시사이에조용한방에서행해졌다. 실험에대해자세한설명을들은참가자들은구미혈 (CV15) 수평선을따라심박센서가장착된탄력밴드를가슴둘레에장착했다. 참가자들은연구자의지시에따라눈을감은채좌위혹은입위의자세에서자발적인평소호흡이나흡기호기의비율이제어된통제호흡을실시했다. 통제호흡동안참가자는음성파일 11 을들으며연구자의지시에따라흡기대호기
42 Ratio of Inhalation and Exhalation and Posture on HRV in Sasang Constitution 를 4대 6 혹은 6대 4로행했다. 호흡법은다음과같이총 2개의군으로구성되었으며호흡의각군에는 5분간행해지는 7개의호흡법이포함되었다. 1) 호장호흡군 (1) 좌위에서평소호흡 (2) 좌위에서분당 6회 ( 흡기4 초 / 회, 호기6 초 / 회 ) 의통제호흡 (3) 좌위에서평소호흡 (4) 입위에서평소호흡 (5) 좌위에서평소호흡 (6) 입위에서분당 6회 ( 흡기4 초 / 회, 호기6 초 / 회 ) 의통제호흡 (7) 좌위에서평소호흡 2) 흡장호흡군 (1) 좌위에서평소호흡 (2) 좌위에서분당6 회 ( 흡기6 초 / 회, 호기4 초 / 회 ) 의통제호흡 (3) 좌위에서평소호흡 (4) 입위에서평소호흡 (5) 좌위에서평소호흡 (6) 입위에서분당 6회 ( 흡기6 초 / 회, 호기4 초 / 회 ) 의통제호흡 (7) 좌위에서평소호흡모든참가자는먼저 10분간의좌위평소호흡으로안정을행한후호장호흡군의호흡법을실시했고 20 분의휴식후흡장호흡군의호흡법을실시했다. 모든참가자들은각군의호흡실시전후에신체에서느껴지는편안함의정도를 10cm길이의선분에표시했다. 모든절차는동국대학교의기관윤리위원회 (Institutional Review Board; IRB) 의승인하에이루어졌다. 3. 분석방법 10cm 의선분에표시된호흡세트전후의주관적 신체상태평가결과는영점에서참가자가표시한위치까지의거리를자로재어 10점만점의척도로환산하였다. 참가자들이다양한호흡법을행하는동안가슴에장착된심박센서가무선으로 RS800CX(Polar Electro Oy, USA) 기기에심박수와심박변이도관련수치들을전송하였다. 취합된수치들은컴퓨터로옮겨져 Kubios HRV software (http://kubios.uef.fi/) 로각호흡구간별평균심박수 (Mean Heart rate; Mean HR), 심박수의표준편차 (Standard deviation of heart rate; STD HR) 가구해졌다. 심전도의시간영역 (Time domain) 에서는심전도상 R파와 R파사이의평균값 (Mean RR), 정상 R파간의표준편차 (SDNN; Standard deviation of normal intervals), RMSSD(The Square root of the mean of the sum of the squares of differences between adjacent normal R-R intervals), 그리고 pnn50{nn50; N-N 사이간격의변화가 50ms 을초과하는시간당평균횟수인 NN50에서 (NN50 count)/(total N-N count) 의계산을통해얻어진값 } 을얻었다. 모든데이터는 Statistical Package for the Social Sciences Version 20 for Windows(SPSS, Somers, NY) 를이용하여분석되었다. 호장호흡군과흡장호흡군에포함된각호흡법의심박변이도측정치의변화와사상체질간의교호작용을보기위하여반복측정분산분석 (Repeated measures Anova; RM-Anova) 을사용하였으며사후분석으로 Fisher s LSD(Least significant difference) 을시행하였다또한특정체질이호장호흡군과흡장호흡군간에심박변이도수치에어떠한차이를보이는지파악하기위하여 Two-way RM-Anova 를실시하였다. 그결과호장호흡군과흡장호흡군군간차이가있는경우사후분석으로각호흡법구간에대해독립 t-test 가행해졌다. 반복측정분산분석에서종속변수가구형성가정을만족하지않는경우에는 Greenhouse-geisser의방법이나 Huynh-Feldt 방법으로유의성을검정했다. 모든결과들은 p-value가 0.05 미만인경우통계적으로유의하다고보았다. 모든데이터는평균 ± 표준편차로표시했다.
JH Kim et al. 43 Ⅲ. 結果 호장호흡군과흡장호흡군의시행전후각사상인의주관적신체상태에대한설문결과흡기와호기의비율을 4대 6으로행하던지 6대 4로행하던지사상인별차이는통계적으로유의하게나타나지않았다. 또한각세트의시행전후비교에서도통계적으로유의미한결과가나오지않았다 (Table 1). 다만기술통계상 소음인은호장호흡군을실시했을때 (3.03±1.97) 가흡장호흡군을실시했을때 (2.82±1.89) 보다신체가다소편해졌지만 (Figure 1-a), 소양인은흡장호흡군을실시했을때 (3.43±2.32) 가호장호흡군을실시했을때 (3.08± 2.12) 보다신체상태가보다편해졌음을알수있다 (Figure 1-b). 태음인은호장호흡군을실시했을때 (2.92±2.38) 나흡장호흡군을실시했을때 (2.86±2.43) 간에평균상큰차이가나타나지않았다. 또한태음인 Table 1. Subjective Scores that Each Sasang Constitution Scored Ranging from 0 to 10 Before and After the 4:6 or 6:4 Ratio of Inhalation and Exhalation and the Posture (N=60; 24 Soeum, 18 Soyang, 18 Taeeum) Sets Sasang Constitution Before After 4:6 Set 6:4 Set Soeum 2.66±2.07 3.03±1.97 Soyang 2.82±2.16 3.08±2.12 Taeeum 2.36±2.28 2.92±2.38 Total 2.62±2.13 3.01±2.11 Soeum 2.70±1.85 2.82±1.89 Soyang 2.92±2.38 3.43±2.32 Taeeum 2.39±2.26 2.86±2.43 Total 2.67±2.12 3.01±2.17 A B C A) Soeum B) Soyang C) Taeeum There are not statistically differences between before- and after-breathing sets in all Sasang-in. Soeum prefers long-exhalation set to long inhalation set of breathing while Soyang prefers long-inhalation to long-exhalation set of breathing. In Taeeum, there are not crucial different between preferences of long-exhalation set or long-inhalation. Figure 1. Subjective scores that each Sasang Constitution before and after the 4:6 or 6:4 ratio of inhalation and exhalation and the change of Posture
44 Ratio of Inhalation and Exhalation and Posture on HRV in Sasang Constitution Table 2. Heart Rate Variability of Sasang Constitution according to the 4:6 Ratio of Inhalation and Exhalation and the Posture (N=60; 24 Soeum, 18 Soyang, 18 Taeeum) Ratio of Inhalation and Exhalation Usual 4:6 Usual Usual Usual 4:6 Usual Posture Sitting Sitting Sitting Standing Sitting Standing Sitting Mean HR (bpm) STD HR (bpm) Mean RR RMSS D pnn5 0 (%) SDNN LF (ms 2 ) HF (ms 2 ) n.u,lf Soeum 79.60±11.66 79.21±11.23 79.90±12.63 89.78±11.44 78.04±11.53 87.13±9.84 80.21±11.06 Soyang 74.68±13.45 73.69±11.07 75.39±11.43 83.98±10.87 76.30±13.34 83.97±10.60 77.45±12.00 Taeeum 74.45±12.31 74.62±12.96 76.08±12.91 87.46±13.47 75.89±11.72 87.66±15.20 76.73±10.71 Total 76.58±12.45 76.18±11.80 77.40±12.34 87.34±11.97 76.87±11.99 86.34±11.80 78.34±11.17 Soeum 7.59±9.26 8.92±5.97 8.47±12.00 13±31.91 8.85±8.28 7.79±4.36 8.84±9.85 Soyang 14.78±33.38 8.30±6.28 6.05±2.50 5.97±1.18 13.20±29 8.89±6.82 9.67±11.14 Taeeum 7.24±4.34 7.06±1.81 7.05±3.55 6.17±1.24 8.41±4.68 8.48±3.16 9.20±5.25 Total 9.64±19.27 8.18±5.18 7.32±7.92 8.84±20.24 10.02±16.73 8.33±4.89 9.19±9.04 Soeum 773.87±104.39 778.92±101.71 775.33±124.31 685.10±88.64 792.63±113.99 702.12±76.71 769.12±110.14 Soyang 832.90±131.25 840.12±123.27 818.00±119.90 729.57±93.50 816.31±130.83 731.43±86.85 799.32±119.63 Taeeum 835.93±148.88 836.86±155.91 820.28±152.74 705.51±109.21 818.92±130.78 711.61±128.61 807.79±120.84 Total 810.20±128.43 814.66±127.61 801.62±131.75 704.56±96.77 807.62±122.80 713.76±96.88 789.78±115.59 Soeum 34.11±22.15 43.65±22.78 32.22±22.18 21.58±13.23 43.06±54.14 28.05±14.80 30.01±14.40 Soyang 39.40±18.57 46.22±24.22 37.22±21.58 21.26±12.63 37.66±21.30 32.35±16.18 34.59±19.75 Taeeum 50.45±28.29 49.35±24.51 45.82±26.38 19.89±7.39 42.19±19.98 33.33±19.47 43.17±25.74 Total 40.60±23.84 46.13±23.45 37.80±23.64 20.98±11.42 41.18±37.33 30.92±16.61 35.33±20.36 Soeum 10.26±11.62 15.52±11.75 9.28±11.54 2.63±4.76 13.07±13.61 6.65±7.20 9.09±10.28 Soyang 15.66±13.3 18.51±11.74 10.57±10.06 3.37±5.73 14.82±15.56 6.92±5.85 10.42±12.45 Taeeum 20.74±16.42 22.54±15.27 15.12±13.42 2.96±2.87 17.68±13.08 8.15±8.95 16.55±14.81 Total 15.02±14.16 18.52±13.01 11.42±11.8 2.95±4.56 14.98±13.96 7.18±7.32 11.72±12.63 Soeum 53.65±26.11 71.97±24.88 54.98±27.27 46.42±18.78 69.89±42.05 58.97±22.43 64.82±24.37 Soyang 56.25±15.95 78.94±25.72 62.47±28.04 51.23±16.87 66.06±22.98 65.49±19.92 69.94±32.94 Taeeum 72.75±32.10 80.59±23.79 76.75±55.49 50.68±18.77 82.08±39.96 67.10±25.43 84.73±37.50 Total 60.16±26.57 76.65±24.71 63.76±38.56 49.14±18.05 72.4±36.67 63.36±22.59 72.33±31.95 Soeum 754.58±729.59 3564.93±2349.57 1044.64±1161.68 573.86±534.81 957.17±1151.79 2062.52±1690.81 805.36±801.29 Soyang 971.02±732.99 3882.16±2047.54 1057.56±809.96 570.87±439.57 771.16±554.93 1992.19±1337.62 1188.50±1342.41 Taeeum 1230.85±1247.25 4473.42±2650.28 1280.41±741.68 755.40±752.52 1163.87±1066.06 2152.54±1327.06 1774.01±2184.66 Total 962.39±922.02 3932.65±2351.36 1119.25±940.72 627.43±580.93 963.38±978.21 2068.43±1463.34 1210.90±1519.38 Soeum 507.64±619.07 524.77±653.04 514.26±750.51 152.27±150.05 517.88±998.99 222.40±339.17 323.70±402.77 Soyang 647.92±699.10 734.74±1212.3 423.47±377.99 137.45±147.91 487.63±620.97 269.56±316.38 417.56±456.40 Taeeum 909.48±1057.12 574.29±683.94 788.67±819.05 157.58±127.79 815.65±954.98 259.06±360.64 765.79±1294.99 Total 670.28±800.37 602.61±855.88 569.34±690.25 149.42±140.90 598.14±885.27 247.55±334.08 484.48±801.56 Soeum 63.28±19.81 88.19±9.48 72.82±14.04 76.65±18.56 69.69±15.79 89.34±12.42 72.45±14.68 Soyang 63.73±21.72 87.47±11.20 73.79±14.23 81.23±9.57 66.91±19.86 89.05±7.41 72.48±17.97 Taeeum 61.68±20.87 89.60±8.62 68.00±17.61 81.03±10.46 61.77±14.77 89.92±7.71 72.27±12.68 Total 62.94±20.38 88.40±9.66 71.67±15.18 79.34±14.04 66.48±16.87 89.43±9.65 72.40±14.94
JH Kim et al. 45 Ratio of Inhalation and Exhalation n.u.hf Usual 4:6 Usual Usual Usual 4:6 Usual Soeum 36.63±19.79 11.73±9.41 26.78±13.64 23.17±18.27 30.02±15.43 10.55±12.25 27.48±14.66 Soyang 36.10±21.58 12.43±11.02 26.14±14.21 18.70±9.56 32.99±19.87 10.88±7.35 27.43±17.91 Taeeum 38.18±20.73 10.33±8.54 31.85±17.50 18.92±10.44 38.08±14.65 10.03±7.67 27.67±12.69 Total 36.94±20.28 11.52±9.55 28.11±15.00 20.56±13.88 33.33±16.73 10.49±9.55 27.52±14.92 HR: Heart rate RR: Intervals between R-R waves in electrocardiogram STD HR: Standard deviation of heart rate SDNN: Standard deviation of N-N(Consecutive normal sinus intervals) intervals RMSSD: Root-mean square differences of successive R-R intervals NN50: Mean number of times per hour in which the change in N-N intervals exceeds 50 milliseconds. pnn50: (NN50 count) / (total N-N count) LF: Low frequency HF: High frequency n.u.: Normalized unit {n.u.lf = LF/(LF+HF); n.u.hf=hf/(lf+hf)} 은전반적으로호흡법실시전후의수치들이사상인의평균보다는낮은것으로나타났다 (Figure 1-c). 다음으로심박변이도에해당하는 10개의수치를살펴보면사상체질별로반복측정분산분석을시행한결과호장호흡군과흡장호흡군에해당하는모든측정지표에서호흡법과체질간의교호작용은나타나지않았다 (Table 2, 3). 기술통계상의평균값으로사상인별로특별하게나타나는경향성을살펴볼때평균심박수의경우흡기와호기비율과는상관없이각세부호흡법에서전반적으로소음인, 태음인, 소양인순의순서를보였으며흡장호흡군의마지막좌위평소호흡에서만이러한경향성은변화되어태음인, 소양인, 소음인순으로평균심박수가낮았다. 평균RR값의경우소음인은모든호흡에서다른사상인보다낮은수치를기록했다. SDNN(Standard deviation of N-N intervals) 의경우전반적으로소음인, 소양인, 태음인순으로수치가높았다. 특히태음인은호장호흡군에서는입위평소호흡후좌위평소호흡으로돌아올때 SDNN 의변화량이가장컸으며호장호흡군이나흡장호흡군모두입위통제호흡을행한후좌위평소호흡으로돌아올때의 SDNN 의변화량이가장컸다. pnn50 의경우흡기호기의비율과상관없이전반적으로태음인, 소양인, 소음인순으로감소했다. LF의경우사상인중태음인이흡기호기의비율에상관없이좌위 0.1Hz 통제호흡시가장높은수치를보였으며입위 0.1Hz 통제호흡후실시된좌위평소호흡에서소음인, 소양인보다높은수치의 LF를보였다. Ⅳ. 考察 東醫壽世保元四象草本卷 에서는사상인의수면중호흡정도를비교하면서양인 ( 陽人 ) 의경우호흡이완만하고단정하면좋으며음인 ( 陰人 ) 의경우호흡이크고웅장하면좋다고하였다 11. 이처럼사상의학 ( 四象醫學 ) 에서는생리상태에서도체질별로호흡양상에차이가있음을언급하였다. 그러므로우리는의식적인호흡법을행할때에도사상인별로호흡양태의차이가나타날수있을것이라보고다양한호흡양상중에서먼저흡기와호기의비율변화에의해주관적설문지표와객관적심박변이도지표가차이가날수있는지에대하여평가했다. 또한호흡의양상뿐만아니라좌위혹은입위의자세에의해서도차이가나는지를함께살펴보았다. 먼저호흡법실시전후의주관설문지결과를살펴보면사상인별로통계적으로큰차이가나타나지않는것을알수있었다. 이는주관적인개인의상태가다양하여각수치의편차가컸기때문으로보이며우리가설계한흡기와호기가 4:6, 6:4의비율로이루어진호흡법이생리지표들의순간적인변화를일으킬
46 Ratio of Inhalation and Exhalation and Posture on HRV in Sasang Constitution Table 3. Heart Rate Variability of Sasang Constitution according to the 6:4 Ratio of Inhalation and Exhalation and the Posture (N=60; 24 Soeum, 18 Soyang, 18 Taeeum) Ratio of Inhalation and Exhalation Usual 6:4 Usual Usual Usual 6:4 Usual Posture Sitting Sitting Sitting Standing Sitting Standing Sitting Mean HR (bpm) STD HR (bpm) Mean RR RMSSD pnn50 (%) SDNN LF (ms2) HF (ms2) n.u,lf Soeum 38.88±27.56 45.43±24.28 35.77±16.58 20.67±12.05 40.00±23.84 31.79±18.48 31.48±20.38 Soyang 31.20±17.55 43.93±16.41 32.72±21.15 21.03±12.95 35.67±22.93 32.05±20.35 37.86±22.39 Taeeum 41.47±21.80 55.86±38.50 38.70±18.40 26.76±14.83 46.38±22.65 30.37±18.11 51.44±36.20 Total 37.35±23.23 48.11±27.59 35.73±18.41 22.60±13.26 40.61±23.21 31.44±18.64 39.38±27.47 Soeum 78.59±10.71 77.90±9.27 80.69±8.47 89.45±11.09 80.46±10.51 87.54±9.74 80.50±9.56 Soyang 76.71±11.05 76.08±9.83 78.85±11.41 86.57±11.44 76.93±11.13 85.18±9.40 77.86±11.11 Taeeum 76.34±12.05 75.96±11.52 78.65±10.34 88.25±13.12 77.52±12.67 88.10±15.41 77.55±12.69 Total 77.35±11.08 76.77±10.02 79.53±9.86 88.23±11.69 78.52±11.30 87.00±11.50 78.82±10.93 Soeum 782.10±98.46 790.12±89.87 758.01±76.86 685.05±86.06 767.50±98.06 700.39±81.19 762.92±90.15 Soyang 803.23±117.37 810.60±104.57 783.30±115.28 709.23±97.23 803.01±115.48 719.76±83.97 794.39±112.00 Taeeum 811.33±132.99 822.49±132.12 783.82±107.38 702.10±101.97 805.81±135.64 708.51±129.18 806.92±140.49 Total 797.21±114.06 805.97±107.33 773.34±98.05 697.42±93.37 789.65±115.00 708.64±97.34 785.56±113.32 Soeum 9.32±17.14 10.93±13.28 8.73±9.48 6.81±2.12 13.61±26.24 8.77±5.18 8.85±8.37 Soyang 5.49±1.71 8.64±3.81 6.69±2.08 6.40±1.53 7.38±3.74 8.67±5.65 10.73±13.19 Taeeum 6.06±1.95 16.31±35.84 8.37±4.45 12.01±11.32 16.01±26.02 7.89±1.71 9.20±3.54 Total 7.19±10.93 11.86±21.27 8.01±6.54 8.25±6.75 12.46±21.90 8.48±4.54 9.52±9.04 Soeum 11.80±13.30 18.22±14.63 9.21±9.30 3.26±4.83 11.38±12.02 8.01±10.93 9.62±11.04 Soyang 10.69±12.76 16.31±10.32 9.23±9.43 3.44±6.28 12.85±13.00 6.81±7.71 12.18±12.47 Taeeum 17.54±16.06 20.67±16.83 12.84±11.02 4.71±4.81 16.44±13.80 9.34±9.87 18.06±15.66 Total 13.19±14.10 18.38±14.10 10.30±9.86 3.75±5.25 13.34±12.83 8.05±9.63 12.92±13.25 Soeum 58.17±37.43 78.09±27.03 64.07±25.46 52.15±22.51 70.39±29.22 64.17±25.32 66.74±30.03 Soyang 64.21±46.92 80.41±26.39 71.72±43.79 53.24±19.69 71.83±37.17 67.18±22.07 70.60±22.78 Taeeum 68.08±36.72 92.08±37.46 74±31.36 65.96±23.66 75.72±29.25 69.39±29.32 94.25±55.78 Total 62.95±39.83 82.98±30.44 69.35±33.29 56.62±22.55 72.42±31.34 66.64±25.35 76.15±39.28 Soeum 845.54±705.60 4084.44±3204.46 1285.46±1085.1 853.77±1121.55 1031.79±1008.15 2937.99±2608.17 974.26±1354.39 Soyang 888.54±583.28 4203.27±2137.46 1884.10±2602.91 651.08±542.79 966.22±762.84 2459.92±2173.59 1259.09±1010.38 Taeeum 1258.48±1227.73 5400.88±5745.07 1549.41±1058.65 1050.81±881.03 1212.66±861.65 2775.88±2365.94 3268.89±6549.84 Total 982.32±871.77 4515.02±3895.39 1544.24±1672.30 852.07±907.35 1066.38±887.63 2745.94±2380.39 1748.10±3793.75 Soeum 554.60±759.30 1643.69±5107.19 579.32±872.30 187.81±443.55 505.32±719.32 338.26±613.87 410.44±681.00 Soyang 314.32±283.57 363.05±359.71 393.08±457.77 149.44±251.75 610.27±1054.73 399.64±991.45 324.87±300.42 Taeeum 610.05±730.23 789.29±1218.14 512.81±611.01 319.09±432.01 610.79±576.86 207.16±301.04 1480.00±2755.41 Total 499.15±645.75 1003.18±3307.39 503.50±686.05 215.68±391.98 568.44±787.93 317.35±679.85 705.64±1630.04 Soeum 65.72±18.39 85.53±19.88 74.54±16.84 85.92±7.37 72.09±15.60 91.43±6.23 73.19±9.89 Soyang 74.68±12.89 90.83±8.50 80.13±11.03 83.82±10.12 70.67±17.07 91.00±13.88 80.08±8.89 Taeeum 68.02±14.55 88.66±10.57 77.74±10.19 79.29±15.79 67.59±17.92 93.63±5.62 72.16±13.47 Total 69.10±15.98 88.06±14.56 77.18±13.46 83.30±11.42 70.31±16.58 91.96±9.00 74.94±11.18
JH Kim et al. 47 Ratio of Inhalation and Exhalation n.u.hf Usual 6:4 Usual Usual Usual 6:4 Usual Soeum 34.16±18.32 14.30±19.50 25.33±16.60 14.03±7.33 27.72±15.35 8.53±6.16 26.69±9.84 Soyang 25.26±12.87 9.13±8.45 19.82±11.00 16.14±10.10 29.19±16.87 8.89±13.54 19.81±8.84 Taeeum 31.89±14.50 11.31±10.53 22.14±10.06 20.62±15.64 32.26±17.73 6.34±5.59 27.77±13.44 Total 30.81±15.92 11.85±14.34 22.72±13.30 16.64±11.34 29.52±16.37 7.98±8.82 24.95±11.14 HR: Heart rate, RR: Intervals between R-R waves in electrocardiogram, STD HR: Standard deviation of heart rate, SDNN: Standard deviation of N-N(Consecutive normal sinus intervals) intervals, RMSSD: Root-mean square differences of successive R-R intervals, NN50: Mean number of times per hour in which the change in N-N intervals exceeds 50 milliseconds, pnn50: (NN50 count)/(total N-N count), LF: Low frequency, HF: High frequency, n.u.: Normalized unit {n.u.lf = LF/(LF+HF); n.u.hf=hf/(lf+hf)} 수는있지만강한자극에는해당하지않기때문으로생각된다. Cappo BM와 Holmes DS 의연구결과 12 에의하면흡기나호기어느한쪽을빠르게하고다른한쪽을느리게하거나동등하게하더라도심박변이도에대한생리지표는변화가없었다. 다만전기자극으로위협자극을주기전공포시기와위협을당하는직면시기에서만생리지표의변화가나타났다. 그러므로우리실험에서처럼정신적위협이없는상태에서행해지는호흡법은개인이큰변화를느끼기에는부족한자극이였다고생각된다. 비록통계적으로유의한사상체질별차이는나타나지않았으나기술통계상평균을비교해볼때소음인은 4:6호흡으로구성된호장호흡에좀더편안함을느꼈고소양인은 6:4호흡으로구성된흡장호흡에좀더편안함을느꼈다. 이는소음인은신대비소 ( 腎大脾小 ) 하며평소에간간히한숨을쉬는경우가있다는점에서소음인의경우호기가긴것이좀더편안하게느껴지는것으로추정해볼수있다. 반면소양인은상체가발달하며비대신소 ( 脾大腎小 ) 하므로흡기가좀더긴것을편안하게느낀것으로추정해볼수있다. 반면태음인은흡기혹은호기어느쪽이긴것에도선호도를보이지않았으며주관설문점수의평균점수보다전반적으로낮은경향을보였다. 다음으로호흡이생체에미치는영향을보기위하여우리는체질별로호장호흡군과흡장호흡군을행하였을때심박변이도지표들이변화하는것을관찰하였다. 심박변이도는시간영역 (Time domain) 과주파수영역 (Frequency domain) 으로나눠분석해볼수있는데 시간영역의 SDNN 은전반적인심박변이도의정도를파악할수있는중요한지표이며 RMSSD와 pnn50 은 RR간의간격을통계적으로처리하여부교감성성분을파악하는지표에해당한다. 또한주파수영역의 VLF(Very low frequency; <0.04Hz) 는신장의레닌- 안지오텐신계 (Renin-Angiotensin system) 와온도의변화를반영하지만주기가길기떄문에 24시간정도의기록으로분석될수있으므로주로 5분정도의짧은심전도기록시에는 HF(0.15Hz-0.4Hz) 와 LF(0.04-0.15Hz) 가사용된다 13. HF 는부교감신경의활성도를파악하는성분으로생각되었으며, LF는교감신경을위주로부교감신경도혼재되어있는성분으로알려져있었으나최근연구결과는자율신경의지배가 LF나 HF 어느한주파수영역에한정되어있는것이아니라전반적인심박변이도전체를교감신경과부교감신경이관장하는것이며, 다만자율신경이관여하는생리현상중 LF는혈관의긴장정도와압수용체반사 (Baroreflex) 의상태를보여줄수있고, HF 는호흡수와일회호흡량에의해좌우되는호흡동성부정맥을반영하는것임을보고했다 14. 우리는이러한심박변이도에서측정된수치를반복측정분산분석으로분석해보았다. 그결과호장호흡군내혹은흡장호흡군내의 7개의세부호흡법과사상체질간의교호작용은심박변이도 10개지표모두에서통계적으로유의한결과를보이지않았다. 다만기술통계측면에서평균값이두드러진사상인은태음인이였다. 심박변이도를파악하는지표인 SDNN 의경우태음인의수치가다른사상인보다평균적으로높
48 Ratio of Inhalation and Exhalation and Posture on HRV in Sasang Constitution 은편이였다또한호장호흡군에서는입위평소호흡후좌위평소호흡으로돌아올때혹은호장호흡군이나흡장호흡군에서입위통제호흡을행한후좌위평소호흡으로돌아올때태음인의 SDNN 의변화량이가장컸다. 부교감성지표인 pnn50의경우흡기호기의비율과상관없이전반적으로태음인, 소양인, 소음인순으로감소했으므로태음인이가장부교감신경이민감한것으로나타났다. 이것은사상인중태음인이부교감신경의우세가두드러져서심박변이도가상대적으로높게나타나는것이라고생각할수있다. 한편 LF의경우도태음인이흡기호기의비율에상관없이좌위 0.1Hz 통제호흡시가장높은수치를보였으며입위 0.1Hz 통제호흡후실시된좌위평소호흡에서소음인, 소양인보다높은수치의 LF를보였다. 낮은호흡수와높은일회호흡량에반응하는호흡동성부정맥은평소호흡시 HF의영역과연관되어있으나우리실험처럼호흡수를낮춰서호흡주파수가 LF의영역에놓이게되면호흡성분인호흡동성부정맥과혈압성분인압수용체반사가서로중첩되면서 LF영역이증가하게된다 15. 그러므로태음인의 LF가다른인보다상승하는것은호흡동성부정맥현상이태음인에게우세하게나타난것으로볼수있다. 우리실험에서는호흡에관한지표를측정하지못했으나아마도태음인의경우다른사상인보다일회호흡량이크기때문에이러한결과가나타난것으로예측해볼수있다. 한편소음인의경우사상인중에서가장낮은 SDNN 값을보여심박변이도가낮은것으로나타났다. 또한평균RR값의경우흡기호기를막론하고모든호흡에서다른사상인보다낮은수치를기록했다. 하지만이와달리평균심박수의경우호장호흡군에서는평균RR값의결과와동일하게소음인이모든호흡에서다른사상인보다높은수치를기록한반면, 흡장호흡군의경우태음인이높은수치를기록하게되어태음인, 소음인, 소양인순서대로각호흡법에서의평균심박수는감소한다. 이러한측면이소음인의주관설문지에서흡장호흡군을불편하다고느낀것과연관이 있을것으로추정해볼수있지만소양인은흡기호기를막론하고대체로모든호흡에서다른사상인보다높은평균RR값과낮은평균심박수를일관되게보이므로소양인에대해설명할수없으므로이에대해서는추가적인연구가필요할것으로보인다. 기존연구에의하면 8 평균심박수의경우흡기집중시에는소음인이태음인보다높았으며복강진폭의경우모든호흡시소음인이태음인보다유의하게높았다. 우리실험의흡장호흡군을흡기집중호흡이라고볼때소음인이태음인보다평균심박수가낮아지는현상은기존의연구와일치하지않지만 5분간의흡기집중호흡을행한기존연구와 12분가까이자세의변화가동반되는호흡세트를행한우리연구와차이를보이는것이라고생각한다. 우리실험에서특이할만한점은소음인맥이느리고약하다고기재되어있으나 7 실제로모든사상인중에서가장빠르게나타났다는점이특징적이라고할수있다. 결과적으로소음인은평균 RR 값이가장낮으므로평균적인부교감신경의작용이가장낮으며 SDNN 은낮으므로심박변이도도낮은것으로보인다. 이는소음인이다른사상인보다부교감신경의활성도가낮다는것을반영한다. 마지막으로소양인의경우태음인과소음인의중간정도에해당하는 SDNN 값을보여심박변이도는다른태음인보다는낮고소음인보다는높은것으로생각되며평균 RR값은가장높고평균심박수는가장낮은특징을보인다. 우리실험은사상체질간의호흡의경향성을자세와흡기호기의비율관점에서파악하려고했으나실제호흡지표를측정하지못하고심박변이도로대체하여살펴보았다는한계를갖는다. 또한심박변이도의주파수영역은호흡변화뿐만아니라, 혈압의변화에따른압수용체반사나호흡중추에서전달되는자율신경, 폐신장수용체의확장자극, Bainbridge reflex 처럼다양한생리기전들이총체적으로반영되어나타나므로 16 추후체질간에뚜렷한변화가나타나지않았던심박변이도외에호흡이나혈압에관련된다양한생리지표를함께파악하는시도가요구된다.
JH Kim et al. 49 Ⅴ. 結論 1. 주관설문지상호흡시자세와흡기와호기의비율변화는사상체질간에통계적으로유의한차이를보이지않았다. 다만기술통계적측면에서소음인의경우 4:6 의흡기호기비율로구성된호흡에좀더편안함을느꼈고, 소양인의경우 6:4의흡기호기비율로구성된호흡에좀더편안함을느꼈으며, 태음인의경우흡기호기비율에대한선호도는없는것으로보였다. 2. 심박변이도수치상에서호흡시자세와흡기와호기의비율변화는사상체질간에통계적으로유의한차이를보이지않았다. 다만기술통계적측면에서소음인은흡기호기비율에상관없이다른사상인보다낮은평균RR값을갖으며다른사상인보다 SDNN 이낮아가장저조한심박변이도를보인다. 소양인의경우흡기호기의비율과상관없이다른사상인보다높은평균 RR값, 낮은평균심박수그리고중간정도의 SDNN 값을가진다. 태음인은흡기호기의비율과상관없이가장높은 SDNN 수치를보여높은심박변이도의경향성을보였으며이것은 0.1Hz 의통제호흡의영향을많이받기때문으로보인다. Ⅵ. 感謝의글 본논문은 2014년정부 ( 교육부 ) 의재원으로한국연구재단의지원을받아수행된연구임 (NRF-2014S 1A- 5B6A02049047). Ⅵ. References 1. Lee JS, Kim JD. Culture:Consideration of breathing in curing(yang-seng) - Focusing on the acceptance of Taesikbeop and Zhu Xi`s Jou-Sic-Jam. KOREAN THOUGHT AND CULTURE. 2015;79(4):593-618. (Korean) 2. Yun HG. Medical Study of Buddha s Breathing Method in AnapanasatiSutra. Journal of SeonStudies. 2012;33(4):125-148. (Korean) 3. Jung SS. The Princile of Regulating the Breath in Classical Yoga Philosophy. The Journal of Indian Philosophy. 2007;22(1):97-131. (Korean) 4. Courtney R. The functions of breathing and its dysfunctions and their relationship to breathing therapy. International Journal of Osteopathic Medicine. 2009; 12:78-85. 5. Oh KM, Kim BK. Clinical Report of One Case with Insomnia, Depression and Anxiety Disorder Improved by Traditional Korean Medical Treatment and Breathing Meditation. J Oriental Neuropsychiatry. 2009;20(3): 297-307. (Korean) 6. Kim BE, Chung DK. A Case Report of Patient with Head Tremor Imporved by Korean Traditional Medical Treatment and Breathing Meditation. The Journal of East-West Medicine. 2013:38(3):85-94. (Korean) 7. Lee JM. Dongeisusebowon. 2nd revision. Seoul: Yeogang. 2003:36, 278. (Korean) 8. Bae HS, Kim JH, Lee YJ, Son HB, Park SS. The Effects of Breath-Counting Meditation on Sasang Constitution. J Sasang Constitut Med. 2015;27(2):231-239. (Korean) 9. Benchetrit G. Breathing pattern in humans: diversity and individuality. Respir Physiol. 2000;122:123-9. 10. Bernardi L, Porta C, Gabutti A, et al. Modulatory effects of respiration. Auton Neurosci. 2001;90:47-56. 11. Ansgar, F., "a blue ring nr.2": a paced breathing in a ten secands rhythm. URL: https://www.youtube.com/ watch?v=slqykhf57ai 12. Park SS. Dongeisusebowon Sasangchobonkwon. 1strev. Seoul: Jipmoondang.2003:232. (Korean) 13. Cappo BM, Holmes DS. The utility of prolonged res-
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