Ming-Jun Chen, Fan-Fu Fang *

1Department of Traditional Chinese Medicine and Acupuncture, Chinese People Liberation Army Hospital, National Clinical Research Center for Geriatric Diseases, China. 2Affiliated Hospital of Traditional Chinese Medicine, Changhai Hospital, Second Military Medical University, China. 3Department of Rehabilitation, Changhai Hospital, Second Military Medical University, China.

Abstract Objective: To evaluate the effect of different training methods of Tai Chi on Chinese medicine constitution of international students with depression or depression tendency. Methods: Thirty-eight Africa international students were randomly divided into the physical exercise group who receiving the simple physical exercise of simplified 24-form Tai Chi (physical exercise group) and the breathing group who receiving both deep breathing method plus simple physical exercise(breathing group). The average scores of Chinese medicine gentleness and various biased constitutional types in the two groups were compared. Results: The average score of thirty-eight students with biased constitution in both groups decreased significantly compared with that before training (P ＜ 0.05). Compared with that before training, the average scores of biased constitutional types in the breathing group, including Qi deficiency, Yang deficiency, phlegm-dampness and Qi stagnation, were significantly decreased (P ＜ 0.05). The average scores of Yang deficiency, blood stasis and Qi stagnation constitutional types of students in simple physical group after training were also significantly decreased after training (P ＜ 0.05). Moreover, the average scores of biased constitutional types, including Qi deficiency, Yang deficiency,Yin deficiency, phlegm and dampness, Qi-stagnation, in the breathing group were significantly lower than those of the simple exercise group, suggesting the superior therapeutic effect of breathing training method (P ＜ 0.01). Conclusion:When combines with the deep breathing method, Tai Chi training achieves better effect on improving the biased constitutional types which may be related to depression or depression tendency, including Qi deficiency, Yang deficiency,Yin deficiency, phlegm and dampness, Qi-stagnation.

Key words: International student, Depression, Depression tendency, Chinese medicine constitution, Tai Chi, Traditional Chinese exercise

Introduction

In recent years, with the expansion of the scale of international education in China, international student education has become an important element of China's international education exchange and cooperation [1].According to statistics from the ministry of education of China in 2010, the number of international students arriving in China has reached 265,000, and they are from 194 countries and regions all over the world [2]. However,due to the influences of cultural backgrounds, language barriers, and environmental changes, the psychological health problems of international students such as depression or depression tendency have become increasingly prominent [3, 4].

JingYueQuanShu (1368～1644，A.D.) said that different constitution determines different emotion. According to the constitution theory of traditional Chinese medicine(TCM), constitution, as a relatively stable inherent characteristic, is affected by the congenital and acquired factor of the human body and heralds the development tendency of human mental disease [5, 6]. Our previous study also found that the constitution of African international students has a correlation with psychological factors such as depression [7, 8]. Compared with gentleness constitution, a healthy condition in TCM,college students with combined biased constitution, a pathological condition in TCM, were more likely suffer from depression [9]. There is also emerging evidence that constitution distribution of population with depression is different from that of population without depression and Qi deficiency, Qi stagnation and Yin deficiency are considered as the common constitutional types in patients with depression [10]. Therefore, it is appropriate to improve the biased constitution through reasonable health interventions for the depressive and high-risk groups of international students.

Tai Chi is a form of mind-body exercise that originated from China [11]. Some research have demonstrated that Tai Chi have beneficial effects for depression management[12-14]. Neuroimaging findings further identified the possible links between the favorable effects of Tai Chi as well as the improved mental health and sleep quality [15].Here, this article studied the influence of different training methods of Tai Chi on Chinese medicine constitution of international students with depression and depression tendency as well as provide a basis for further determination of the role of Tai Chi in improving constitution and thus improving or eliminating depression.

Methods

Depression emotion criteria

As shown in supplementary materials Table 1, Zung's Selfrating Depression Scale (SDS) is used to assess the degree of depression of international students [16]. The SDS contains 20 items and each item is graded on a scale of 1 to 4, of which 10 are positive statements with reverse scores and 10 are reverse statements with positive scores.The score ranges from 20 to 80 points. The standard score is integer part of SDS total score multiplied by 1.25. The degree of depression is graded as follows: no depression (≤49 points), mild depression (50-59 points), moderate depression (60-69 points) and serious depression (≥ 70 points). Some people without depression (45 to 49 points)were diagnosed with depression tendency.

Inclusion criteria

(1) Compliance with the Zung’s SDS for depression or depression tendency (SDS score ≥ 45 points); (2) Insist on the completing a 12-week Tai Chi training; (3) Not suffer from illness or chronic diseases that affect work and life in the past year; (4) Not practiced any form of Tai Chi exercise in the past; (5) Have signed informed consent and are willing to cooperate with this researcher.

Exclusion criteria

(1) Those who have a serious organic disease, such as tumors, uremia, etc.; (2) Those who have physical or mental illnesses and have a significant influence on their collective status; (3) Those who have been found to have a serious organic disease during the investigation; (4)Unwilling to cooperate.

General information

Using the method of cross-sectional sampling, 76 African students were selected from international student population of a certain Shanghai university, and 38 of them conform to the inclusion criteria. According to the chronological order of entering research, students were divided into groups with four persons each group by the method of random area group. The students in each group were randomly divided into the simple physical exercise group of Tai Chi (the simple exercise group) and deep breathing method plus simple physical exercise of Tai Chi(the breathing group).

A total of 19 patients with the average age of 33.18 ±1.91 years old were included in the simple exercise group,including 12 males and 7 females. Six students were diagnosed with mild depression or worse while the others were diagnosed with depression tendency. The mean value of SDS score was 43.63 ± 1.68. At the same time, there were 19 students with the average age of 38.05 ± 2.01 years old in the breathing group, including 15 males and 4 females. Seven students were diagnosed with mild depression or worse while the others were diagnosed with depression tendency. The mean value of SDS score was 46.00 ± 1.80. There was no significant difference between the simple exercise group and the breathing group in the terms of ages and the mean value of SDS score (P ＞ 0.05)(Table 1).

Table 1 Baseline data of the international students

Table 2 Average scores of constitutional types before training

Tai Chi training method

Thirty-eight international students with depression or depression tendency were trained by simplified 24-form Tai Chi, which was promulgated by the State Physical Culture Administration in 1956. The students in the simple physical group only receive the physical exercise. The students in the breathing group followed the principle of“deep breath in with the action of close, deficiency, and adduction while deep breath out with the action of open,excess, and abduction” during the physical practice [17].The deep breathing should be coordinate with the action.The participants in different groups were guided by the coaches on different yard for continuous 12 weeks. Once a week and 30 minutes each time.

Change of constitutional type and rating of TCM

As shown in supplementary materials Table 2-10, TCM constitution was evaluated before and after 12-week Tai Chi exercise according to the standard of “TCM Constitution and Judgment” in 2009 [18]. Each question is divided into 5 options: no, rarely, sometimes, often, always,assigned 1, 2, 3, 4, 5 in order, and each score in subscale are accumulated to get the original score. The conversion score is calculated by the following formula: conversion score = [(original score - the number of items) / (the number of items × 4)] × 100. Each subscale has a conversion score of 0 to 100 points.

Statistical methods

Using the double entry method of EpiData 3.1, the SDS scale and the TCM constitution table data were imported.The data was imported from EpiData 3.1 to SPSS 18.0.The SPSS file was set up for data management and analysis.The measurement data was used for statistics. Comparison using t test, P ＜ 0.05 was considered statistically significant.

Results

Average scores of constitutional types before experiment

As shown in Table 2, there was no significant difference in constitutional type from 1 to 8 of 38 students before receiving Tai Chi training (P ＞ 0.05). However, the inherited type showed significant difference (P = 0.026),indicating larger sample size are needed in further study to obtain reliable evidence (Table 2). Here, only constitutional types from 1 to 8 were studied.

Comparison of constitutional type before and after Tai Chi training

Compared with that before training, the average score of biased constitution of all thirty-eight students decreased significantly (P ＜ 0.05) (Table 3).

Table 3 Average scores of constitutional types before and after training

Comparison of constitutional type before and after different training methods

The average scores of Yang deficiency, blood stasis and Qi stagnation constitutional types of students in simple physical group were significantly decreased after training(P ＜ 0.05). Compared with that before training, the average scores of biased constitutional types in the breathing group,including Qi deficiency, Yang deficiency, phlegmdampness and Qi stagnation, were also significantly decreased (P ＜ 0.05). Moreover, the average score of gentleness constitution increased while those of biased constitutional types, including Qi deficiency, Yang deficiency, Yin deficiency, phlegm and dampness, Qistagnation in the breathing group decreased as compared with those of the simple exercise group, suggesting the superior therapeutic effect of breathing training method (P＜ 0.01) (Tables 4-6).

Table 4 Average scores of constitutional types in the simple physical group before and after training

Table 5 Average scores of constitutional types in the breathing group before and after training

Table 6 Average scores of constitutional types between the simple physical group and breathing group after training

Discussion

Mental concentration, relaxed breathing, and muscle relaxation are key elements of Tai Chi, which make it become an effective non-drug approach in the treatment of psychological conditions. Taijiquankaoxinlu (2006, A.D.)pointed out that practitioners who combined Qi (the flow of internal energy) and Yi (thought) was getting better. It means that Tai Chi can integrate deep breathing with body movements to achieve a balance between the body and mind. However, majority research in home and abroad focuses on exploring the physiological mechanism and clinical efficacy of Tai Chi on human body. Very few research regards deep breathing as a focus. To evaluate the effects of deep diaphragmatic breathing, this article deeply compared the effects of different training methods of Tai Chi, simple physical exercise or deep diaphragmatic breathing plus simple physical exercise on the human body from the perspective of TCM constitution.

Before Tai Chi exercise, the average scores of gentleness constitutional type and biased constitutional type showed no difference between the simple physical group and the breathing group of 38 African students. The inherited type showed significant difference, indicating larger sample size are needed in further study. However, after Tai Chi exercise, the average score of gentleness composition increased while that of all the biased constitution decreased significantly (P ＜ 0.05), indicating that Tai Chi has great potential to change the biased constitutions.

The present study also demonstrated that the efficiency of deep breathing plus simple physical exercise was superior to that of simple physical exercise in improving constitution. It was involved in improving the biased constitutional types including Yang deficiency, Qi stagnation, Qi deficiency and phlegm-damp, which have been shown more likely to suffer from depression [10].The students in the deep breathing group emphasized the close cooperation between breathing and movement during exercise, which is one of the important features of the Tai Chi. Because the cerebral cortex consciously regulates the respiratory frequency and depth, the breathing and movement can be coordinated and unified, thereby keeping Qi smooth and natural as well as mind clear and peace [19].Therefore, on basis of physical exercise, deep breathing training should be of value in improving constitution of international student, and then reduces the generation of depressive emotions.

Conclusion

When combines with the breathing method, Tai Chi training achieves better effect on improving the biased constitution related to depression or depression tendency,opening up a new idea of the breathing training of Tai Chi for future scientific research.