
==== Front
Medicine (Baltimore)
Medicine (Baltimore)
MD
Medicine
0025-7974
1536-5964
Lippincott Williams & Wilkins Hagerstown, MD

MD-D-23-11479
00018
10.1097/MD.0000000000039556
3
5000
Research Article
Clinical Trial/Experimental Study
Relieving effect of jiao-tune of 5-element music on negative emotions in patients with decompensated hepatitis B virus cirrhosis: A randomized and controlled experiment study
Wang Yuan-Yuan BS a
Sun Yue BS a
Zhang Wen-Yun BS a
Yao Yu-Qian MS b
Bian Zhao-Lian MS c
https://orcid.org/0000-0001-7056-3851
Qian Xiang-Yun MS c*
a Hepatology Department, Nantong Third People’s Hospital, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
b Oncology Department, Nantong Third People’s Hospital, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China
c Department of Nursing, Nantong Third People’s Hospital, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China.
* Correspondence: Xiang-Yun Qian, Department of Nursing, Nantong Third People’s Hospital, Affiliated Nantong Hospital 3 of Nantong University, Nantong 226001, Jiangsu, China (e-mail: qxy03062020@126.com).
13 9 2024
13 9 2024
103 37 e3955626 12 2023
27 7 2024
14 8 2024
Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

Background:

Depression and anxiety are common in patients with decompensated hepatitis B virus (HBV) cirrhosis. This study aimed to evaluate the relieving effects of the jiao-tune of 5-element music on negative emotions in patients with decompensated HBV cirrhosis.

Methods:

The patients were randomly allocated into the control group (standard nursing care) and the jiao-tune group (standard nursing care plus a 2-month course of music therapy with the jiao-tune of 5-element music). The negative emotions of patients were assessed before intervention treatment and at the end of the 2-month follow-up using the Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS).

Results:

The analysis included 209 patients, with 102 in the control group and 107 in the jiao-tune group, all of whom returned their completed questionnaires. Baseline clinical characteristics and length of hospital stay were comparable between 2 groups. Before intervention treatment, there were no significant differences in SAS score (55.78 ± 5.64 vs 56.47 ± 3.28) and SDS score (65.13 ± 3.12 vs 64.48 ± 4.47) between the jiao-tune group and control group. After 2-month follow-up, the jiao-tune group had a significantly lower SAS score (53.17 ± 5.61) and SDS score (61.28 ± 1.52) compared with the control group (55.49 ± 3.37 and 63.08 ± 2.76), there were significant differences between 2 groups (P < .001).

Conclusions:

The jiao-tune of 5-element music can relieve the negative emotions in patients with decompensated HBV cirrhosis.

anxiety
depression
hepatic cirrhosis
hepatitis B virus
music therapy
traditional Chinese medicine
Nantong Municipal Health CommissionMSZ2022042, MS2022035 and MSZ2023050 Xiangyun QianNantong Basic Science Research and Social Livelihood Science and Technology Planning Project of Nantong Science and Technology BureauMSZ2022053 Xiangyun QianOPEN-ACCESSTRUE
SDCT
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pmc1. Introduction

Hepatitis B virus (HBV) infection is a major public health problem. It has been reported that the global prevalence of hepatitis B surface antigen (HBSAg) in the general population was 3.8% in 2019, with approximately 1.5 million new cases of HBV infection, 296 million cases of chronic HBV infections, and 820,000 deaths from complications related to HBV infection.[1] Chronic HBV infection is an important risk factor for the development of hepatic cirrhosis. Decompensated hepatic cirrhosis is defined as an acute deterioration of hepatic function in patients with hepatic cirrhosis, which affects more than 10 million people globally.[2,3] The patients with decompensated hepatic cirrhosis can develop severe complications such as esophagogastric variceal bleeding, hepatic encephalopathy and ascites, with a 5-year overall survival rate of 14% to 35%.[3,4] Thus, the decompensated hepatic cirrhosis places heavy financial and psychological burdens on patients, their families and society in general.[4]

The chronic hepatic disease is associated with a reduction in health-related quality of life,[5,6] and many patients with hepatic cirrhosis have a depressed mood.[7] Depression is more prevalent in patients with HBV-related cirrhosis or acute-on-chronic hepatic failure than in healthy people.[8] One survey showed that the incidences of anxiety and depression were 24.5% and 45.9% in HBV-infected patients,[9] and 56.6% and 66.5% in the patients with decompensated HBV cirrhosis, respectively.[10] Furthermore, the depression in patients with chronic HBV infection is associated with the severity of hepatic cirrhosis.[11] Therefore, early screening and emotional intervention are important for patients with decompensated HBV cirrhosis. Five-element music therapy is a part of music therapy, and a health therapy using the 5 tones as a treatment means based on the 5-element theory of traditional Chinese medicine (TCM). The theory of voice pitch of the 5 tones being correlated with the 5 zang viscers was proposed in the Emperor Classic of Internal Medicine.[12] The 5 tones are correlated with 5 organs, 5 organs are correlated with 5 elements, and the 3 parts are integrated, and the patients can listen 5 tones to regulate their 5 organs. The 5 tones refer to Gong, Shang, Jiao, Zhi, and Yu, which correspond to 5 elements such as earth, gold, wood, fire and water, 5 organs such as spleen, lungs, liver, heart and kidneys, and 5 emotions such as miss, worry, anger, joy and fear, respectively. Therefore, each of the 5 elements is correlated with a specific organ: gong is correlated with the spleen, shang is correlated with the lung, jiao is correlated with the liver, zhi is correlated with the heart, and yu is correlated the kidney. Music is played according to the circadian rhythm and the properties of the organs to improve the normal coordination of organ function and promote qi, blood and body fluid.[12,13] The jiao-tune of 5-element music, which corresponds to the wood element and music of the spring, promotes vitality and affects the liver. It can enhance the generation, release and expansion of qi in the body, and exert effects in soothing the liver and relieving anger, nourishing Yang and protecting liver, tonifying the heart and benefiting the spleen, and purging kidney fire, thus it can be used to prevent and treat diseases such as hepatic qi stagnation, rib-side distention and chest tightness, loss of appetite, depressed mood, mental weakness, anxiety and irritability. Previous studies have shown that 5-element music therapy is helpful in the treatment of patients with chronic HBV infection with insomnia.[14] alopecia areata induced by hepatic qi stagnation (depression),[15] post-stroke depression,[16] and depression after chemotherapy for breast cancer.[17] However, no previous reports have examined whether 5-element music therapy might alleviate depression in patients with decompensated HBV cirrhosis.

We hypothesized that the jiao-tune of 5-element music would help to relieve negative emotions in patients with decompensated HBV cirrhosis. Therefore, the aim of this study was to evaluate whether the jiao-tune of 5-element music would reduce the symptoms of depression and anxiety in patients with decompensated HBV cirrhosis.

2. Methods

2.1. Participants

This prospective pilot study included consecutive patients with decompensated HBV cirrhosis who were admitted to the hepatology wards of our hospital between January 2020 and June 2020. Inclusion criteria: patients who aged 18 to 60 years old; those who lived in Nantong City; those diagnosed with decompensated HBV cirrhosis;[18] those with syndrome of liver depression transforming into fire according to TCM Zang-Fu syndrome differentiation theory;[19] and those with SDS[20] and SAS[21] scores of 50 points or more, who had normal cognitive function and were able to communicate and express themselves. Exclusion criteria: patients with severe dysfunction of the heart, brain or kidneys; those with other underlying diseases or acute complications; those who were engaged in music-related work or research; those who were treated with psychiatric drugs such as antidepressants; and those who did not complete the study protocol or returned SDS or SAS questionnaires in which 15% of the items were unanswered.

All eligible patients were randomly divided into the jiao-tune group (n = 102) and the control (n = 107) group by using a simple random number table. Due to the nature of the intervention, the patients were not blinded to the grouping.

2.2. Study methods

The patients in both groups received standard clinical care that included observation, treatment, medication, and guidance with diet, rest and emotional wellbeing. In addition, the patients in the jiao-tune group received a 2-month course of music therapy with the jiao-tune of 5-element music. See Supplementary File 01, Supplemental Digital Content, http://links.lww.com/MD/N509 and Supplementary File 02, Supplemental Digital Content, http://links.lww.com/MD/N510 as a short sample.

The procedures used for music therapy were as follows. An MP3 recording of the jiao-tune in China’s Traditional Wuxing (Five Element) Therapeutic Music (Chinese Medical Multimedia Press) was imported into the patient’s cellphone, and the patient was provided with headphones. According to the orientations of 5 elements, the wood presents the east orientation, thus the music player was placed in the eastern part of the patient.[22] The patient was instructed to self-administer the music therapy when being relaxed and resting comfortably in a quiet environment, and it was ensured that there was no bright light stimulation, and the patients were guided to close their eyes. When the music was being played, the patients were asked to regulate their breathing to be immersed in the rhythms and melodies of the music, The intervener conducted a guided meditation and asked the patients to sing gently or move their bodies to the beat of the music. Subsequently, the patients were asked to express their feelings about the music they had heard. During hospital admission, the night-shift nurses in the wards helped and encouraged the patients in the jiao-tune group to listen to the music at a volume of 25–60 dB according to the patient’s auditory comfort, between 19:00 and 21:00 every day, and the nurse made records. After being discharged from the hospital, the patients in the jiao-tune group received telephone follow-up form the investigators to provide information about their use of music therapy, including the duration and number of listening to music, and the investigator should help the patients or their family members with any issues they had encountered.

2.3. Data collection

All clinical data were obtained by suitably trained investigators. All patients in both groups were followed up for a total 2 months during hospitalization and after discharge from the hospital, corresponding to a period lasting to the end of music therapy for those in the jiao-tune group. The following clinical information was recorded: social and demographic characteristics such as age, gender, education, occupation, marital status, family income and medical insurance details; severity of hepatic cirrhosis on admission based on the Child–Pugh score;[23] length of hospital stay; SDS and SAS scores and hepatic function at 24 hours after admission and at the end of the 2-month study

2.3.1. SDS assessment

The Zung SDS contains 20 items and related questions that collect information regarding recent subjective feelings and somatic symptoms of patients.[20] The patients were asked to rate the frequency of depressive symptoms using a 4-point Likert scale ranging from “a little of the time,” “some of the time,” “a good part of the time” to “most of the time.”[14] The scores of all items were added to be multiplied by 1.25 to obtain a standardized score, and the depression was defined as a standardized score of ≥50 points.[24] The Zung SDS has been reported to have a split-half reliability coefficient of 0.73 and high discriminant and predictive validity.[25,26] The Zung SAS is used to evaluate subjective feelings of anxiety[20] and has the same item ratings and scorSing system as the SDS, with a higher score indicating a poorer mental state,[27] Zung SAS has a Cronbach α of 0.78 and a split-half reliability of 0.75.[28]

2.3.2. Hepatic function test

About 5 mL of fasting elbow venous blood was collected from patients in the early morning before treatment and at 2 months after treatment, and then centrifuged at 4000 rpm and stored at −20 °C for test. A fully automatic biochemical analyzer (Hitachi LABOSPECT 008AS) was used to detect the hepatic function indicators such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and the reagent kits were purchased from Zhejiang Ailex Medical Co., Ltd. All operations were carried out in strict accordance with the instructions. The hepatic function was assessed and grouped using Child–Pugh classification, including grade A (5–6 points), grade B (7–9 points), and grade C (>9 points).

2.4. Data analysis

The data from the questionnaires were input into EpiData 3.0 (EpiData Association, Denmark) independently by 2 investigators, and any discrepancies were checked and corrected. SPSS 17.0 (SPSS Inc., USA) was used for the statistical analyses. Continuous data are presented as the mean ± standard deviation and were compared between groups using Student t test. Categorical data are described as n (%) and were compared between groups using the χ2 test. P < .05 was considered to indicate statistical significance.

2.5. Ethic statement

This study was approved by the Medical Ethics Committee of Nantong Third People’s Hospital (E2016009), and all participants had signed informed consent.

3. Results

3.1. Clinical characteristics of the study participants

Among 226 patients screened with decompensated HBV cirrhosis, 209 patients were included in the final analysis according to the inclusion and exclusion criteria. A total of 102 patients were assigned to the control group, and 107 patients were assigned to the jiao-tune group. No patients were lost to follow-up, and all questionnaires were distributed and collected before and after intervention treatment, with a response rate of 100%.

The clinical characteristics of the study participants are shown in Table 1. There were no significant differences in age, gender, marital status, education level, occupation, monthly income, method of payment of medical expenses, Child–Pugh score or length of hospital stay between the jiao-tune group and the control group.

Table 1 Comparison of general information of the patients with decompensated HBV cirrhosis between 2 groups.

General information		Jiao-tune group
(n = 107)	Control group
(n = 102)	T	P	
Age		47.03 ± 13.96	49.82 ± 12.51	1.712	.097	
Gender	Male	61	58	0.785	.393	
Female	46	44	
Education level	Junior high school	36	39	0.697	.706	
Senior high school/junior college	43	42	
Bachelor degree or higher	28	21	
Marital status	Divorced/ widowed	5	7	0.348	.502	
Married	102	95	
Occupation	Employer	43	41	0.889	.641	
Farmer	39	38	
Other	25	23	
Monthly income	< 3000 RMB/mo	40	34	0.249	.883	
3000 to 5000 RMB/mo	42	45	
>5000 RMB/mo	25	23	
Payment of medical expenses	Medical insurance	1990	89	0.764	.561	
Self-payment	17	13	
Data are presented as mean ± standard deviation or n (%).

3.2. SDS and SAS scores

There was no significant difference in the baseline SDS and SAS scores between 2 groups. However, both the SDS and SAS scores in the jiao-tune group after the intervention were significantly lower than those before the intervention (P < .05; Table 2). By contrast, there were no significant differences in the SDS and SAS scores in the control group between before and after treatment. Additionally, the SDS and SAS scores after treatment were significantly lower in the jiao-tune group than in the control group (P < .05; Table 2).

Table 2 Comparison of Zung SAS score and Zung SDS score before and after intervention between 2 groups.

Item	Group	N	Before intervention		P	
	Jiao-tune group	107	55.78 ± 5.64	53.17 ± 5.61	<.001	
SAS	Control group	102	56.47 ± 3.28	55.49 ± 3.37	.063	
	P		.067	<.001		
	Jiao-tune group	107	65.13 ± 3.12	61.28 ± 1.52	<.001	
SDS	Control group	102	64.68 ± 4.47	63.08 ± 2.76	.685	
	P		.383	<.001		
Data are presented as mean ± standard deviation.

3.3. Hepatic function level

There were no statistic significant differences in ALT, AST and Child–Pugh score in patients with decompensated HBV cirrhosis between 2 groups before intervention treatment. The ALT, AST and Child–Pugh scores in the jiao-tune group were lower than those in the control group after intervention treatment, and there were statistically significant differences between 2 groups (P < .05; Table 3).

Table 3 Comparison of liver function level in patients with decompensated HBV cirrhosis before and after intervention (point, ±s).

Indicators	Group	Cases	Before intervention	After intervention	t value	P value	
ALT	Jiao-tune group	107	58.40 ± 13.50	37.19 ± 7.85	9.741	<.001	
	Control group	102	58.31 ± 15.62	41.50 ± 8.64	2.599	.010	
	t value		0.033	2.354			
	P value		.974	.020			
AST	Jiao-tune group	107	57.19 ± 14.43	37.45 ± 7.94	8.747	<.001	
	Control group	102	56.87 ± 13.56	41.32 ± 8.66	2.508	.013	
	t value		0.119	2.106			
	P value		.905	.036			
Child–Pugh	Jiao-tune group	107	7.63 ± 0.81	5.36 ± 1.13	9.269	<.001	
	Control group	102	7.91 ± 0.83	6.25 ± 1.02	2.141	.033	
	t value		0.432	2.384			
	P value		.568	.018			

4. Discussion

The main findings of this study were that jiao-tune-based music therapy for 2 months was associated with a reduction in the severity of depression and anxiety symptoms in patients with decompensated HBV cirrhosis. Our novel findings suggested that the jiao-tune of 5-element music can alleviate depression and anxiety in patients with decompensated HBV cirrhosis and thereby improve their qualities of life.

Music intervention is based on psychotherapeutic theory and methods. Music therapy is believed to exert both physiological and psychological effects to relieve negative emotions due to various causes.[29,30] Five-element music is a first-of-its-kind result of the perfect combination of TCM theories on Yin-Yang, 5 elements and the unity of heaven, earth and man with the modern music therapy theories. Five-element music has gong, shang, jiao, zhi and yu tunes corresponding to the 5 elements, all of which have beautiful melodies.[31] According to the TCM theory of 5-element music therapy, the jiao-tune is correlated with wood, and is a music played by ancient xiao, zhudi, hulusi, etc, it can promote vitality and growth, regulate mental state, boost mood, regulate the drainage of the liver and gallbladder, support the heart and harmonize the stomach. The patients with decompensated HBV cirrhosis have a poor prognosis and a high mortality, and their treatments are both challenging and costly due to the presence of severe complications such as ascites, infection and bleeding.[18] The long course of the disease causes physical discomfort, low self-esteem, cognitive dysfunction and an increasing psychological burden, further resulting in emotional injuries, hepatic qi stagnation and negative emotions such as anxiety and depression.[32]

Numerous previous studies have reported that 5-element music therapy can alleviate symptoms of depression and/or anxiety in various groups of patients, including elderly people with seasonal affective disorder,[33] women with depression,[34] women with perinatal anxiety or depression,[35] patients with post-stroke depression,[36] and patients with cancers.[13,37] Consistent with the results of these previous investigations, this study showed that 2 months of therapy with the jiao-tune of 5-element music was effective in relieving the symptoms of depression and anxiety in patients with decompensated HBV cirrhosis.

This is mainly due to the fact that the jiao-tune affects the liver through the meridians and collaterals, exerts the resonance effect between 5 tunes and 5 organs, regulate the function of Zang-Fu organs, and qi and blood. The emotions are normal when the qi and blood in the body are in harmony. Therefore, the jiao-tune exerts a dual regulatory effect on the Zang-Fu function and emotional state of the human body. Modern medicine believes that feeling a sense of happiness and pleasure originates from the regulation of the β-endorphin(β-END)/μ opioid receptor (MOR) system in the central nervous system. The music therapy can reduce the sympathetic activity and stimulate the pituitary gland to release morphine to arouse a sense of the pleasure in the body, thus improving the negative emotions.[38] In a study by Dan Yuqin et al,[39] it was observed by resting-state functional magnetic resonance imaging that the jiao-tune of 5-element music can activate the orbitofrontal cortex and middle temporal gyrus, which are important brain regions of the emotional circuit, thus improving the depressed mood this is consistent with the theory of “the Five Organs Harmonize Pitch” in the Yellow Emperor’s Classic of Internal Medicine. It is said in Evil Spirits and Their Influence that: The liver corresponds to wood, it is jiao-tune in music rhythm, and anger in emotional expression; the heart corresponds to fire, it is zhi tune in music rhythm, and joy in emotional expression; the spleen corresponds to earth, and it is gong tune in music rhythm, and miss in emotional expression; the lungs correspond to gold, and it is shang tune in music rhythm, and worry in emotional expression; and the kidneys correspond to water, and it is yu tune in music rhythm, and fear in emotional expression.[40]

Based on TCM theory, the jiao-tune is corrected with the wood, and has a gentle and refreshing melody, and can affect the liver to cause physiological and psychological changes in patients with decompensated HBV cirrhosis, thereby improving emotional depression, relieving hepatic qi stagnation, anxiety, sadness and fear, and eventually alleviating physical and mental discomfort. This study showed that the hepatic function levels of patients in both groups after the treatment were decreased compared with those before treatment, and the differences were statistically significant (P < .05). However, the intergroup comparison showed that the hepatic function level in the patients in the jiao-tune group was lower than that in the control group after treatment. It can be seen that the jiao-tune of 5-element music has a certain auxiliary intervention effect in improving hepatic function.

The observations during hospital stay revealed a relaxation in the facial features of patients when the music was being played, and some patients would make body movements while following the rhythms and beats of the music. After listening to the music, 1 patient expressed his feelings and said, “I have been sick for so many years, which poses a great burden on my family, and my work is affected. I’ve been feeling hopeless and depressed. The music gives me hope. It feels like everything is starting to sprout in early spring after a winter, and the grass is starting to grow. I imagine a picture full of life and vigor., and thus I feel better.”

After listening to the music, some patients said that they were going to be positive, cooperative with their treatment, manage their health better, improve their qualities of life, and enjoy their lives as much as possible. The feedbacks from patients indicate that the jiao-tune can improve the mental state of patients with decompensated HBV cirrhosis, relieve their anxiety and depression, and enhance their initiative to receive treatment.

To optimize the effects of music therapy with the jiao-tune, it is crucial to provide patients with appropriate guidance to ensure that they are relaxed, resting comfortably and wearing their headphones properly in a quiet environment, and they have selected an appropriate volume before playing the music. When the music therapy is administered under supervision in a hospital setting, the patient should be closely observed for changes in vital signs and disease status. Additionally, after the music has been played, the patient should be interviewed to record their feelings. Appropriate scheduling and encouragement from nursing staff can help to improve patient’s adherence and persistence to music therapy. Before discharge from the hospital, the patients and their main caregivers should receive clear guidance regarding the continuation of music therapy, and adherence to a regular schedule can be improved through reminder calls from caregivers or the use of cellphone alarms.

We also recommend that each patient should be assigned with a member of medical staff who can provide assistance, reminders and supervision. Additionally, the patients should be followed up and evaluated after the end of music therapy.

5. Limitations

This study has some limitations. First, this was a single-center study with a small sample size, which may limit the generalizability of the findings. Second, the patients were not blinded to the intervention, which may have introduced bias. Third, in this study, although the patients not receiving music therapy were enrolled into the control group, no other comparator groups (e.g., patients listening to other types of music) were established. Fourth, the whole follow-up time was only 2 months, so the longer-term effects of music therapy were not assessed. Fifth, only the jiao-tune of 5-element music was evaluated. Sixth, the study did not include patients with decompensated cirrhosis due to other causes.

6. Implications and recommendations for practice

The jiao-tune of 5-element music can effectively relieve the negative emotion in patients with decompensated HBV cirrhosis. The results of this study provide an important reference for how to use traditional music to regulate the negative emotions in patients with chronic diseases, and this method can be considered as a safe and inexpensive non-pharmacological auxiliary method. In the future, we will carry out a further study on the emotional factors and related mechanisms in patients with decompensated HBV cirrhosis, such as the changes of hormones in patients before and after intervention. And the study sample size, study area and outcome indicators should be expanded.

7. Conclusions

The therapy with the jiao-tune of 5-element music can relieve negative emotions in patients with decompensated HBV cirrhosis. This study suggests that this form of music therapy can be used as a straightforward and inexpensive treatment for depression and anxiety in patients with decompensated HBV cirrhosis. However, further studies are needed to explore the potential role of 5-element music therapy in the treatment of depression and anxiety in patients with chronic decompensated HBV cirrhosis with more details.

Acknowledgments

We are very grateful to the Nursing Department and Infectious Disease Department of Nantong Third People’s Hospital, Nantong University, for their support in the recruitment of the participants. We are also very grateful to all the patients who agreed to participate in this study.

Author contributions

Conceptualization: Yuan-Yuan Wang.

Data curation: Wen-Yun Zhang.

Funding acquisition: Xiang-Yun Qian.

Investigation: Yuan-Yuan Wang, Yu-Qian Yao.

Methodology: Yuan-Yuan Wang, Yue Sun.

Resources: Yue Sun.

Supervision: Zhao-Lian Bian.

Writing – original draft: Yuan-Yuan Wang, Xiang-Yun Qian.

Writing – review & editing: Xiang-Yun Qian.

Supplementary Material

Abbreviations:

ALT alanine aminotransferase

AST aspartate aminotransferase

HBSAg hepatitis B surface antigen

HBV hepatitis B virus

MOR μ opioid receptor

SAS Zung Self-Rating Anxiety Scale

SDS Self-Rating Depression Scale

TCM traditional Chinese medicine

β-END β-endorphin (β-END)

This study was supported by Nantong Municipal Health Commission (MSZ2022042, MSZ2022035, and MSZ2023050) and Nantong Basic Science Research and Social Livelihood Science and Technology Planning Project of Nantong Science and Technology Bureau (MSZ2022053).

The authors have no conflicts of interest to disclose.

The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.

Supplemental Digital Content is available for this article.

How to cite this article: Wang Y-Y, Sun Y, Zhang W-Y, Yao Y-Q, Bian Z-L, Qian X-Y. Relieving effect of jiao-tune of 5-element music on negative emotions in patients with decompensated hepatitis B virus cirrhosis: A randomized and controlled experiment study. Medicine 2024;103:37(e39556).

Y-YW and YS contributed equally to this work.
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References

[1] Hepatology Branch of Chinese Medical Association. 2022 Infectious Disease Branch of Chinese Medical Association. Guideline of prevention and treatment for chronic hepatitis B. Chin J Infect Dis. 2023;41 :3–28.
[2] GBD 2017 Cirrhosis Collaborators. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2020;5 :245–66.31981519
[3] Mansour D McPherson S . Management of decompensated cirrhosis. Clin Med (Lond). 2018;18 (Suppl 2 ):s60–5.29700095
[4] Hepatology Branch of Chinese Medical Association. Infectious Disease Branch of Chinese Medical Association. 2019 Guideline of prevention and treatment for chronic hepatitis B. Chin J Infect Dis. 2019;27 :938–61.
[5] Cortesi PA Conti S Scalone L . Health related quality of life in chronic liver diseases. Liver Int. 2020;40 :2630–42.32851764
[6] Donlan J Zeng C Indriolo T . The Edmonton symptom assessment system is a valid, reliable, and responsive tool to assess symptom burden in decompensated cirrhosis. Hepatol Commun. 2024;8 :e0385.38497942
[7] Dong N Chen WT Bao M Lu Y Qian Y Lu H . Self-management behaviors among patients with liver cirrhosis in Shanghai, China: a cross-Sectional study. Clin Nurs Res. 2020;29 :448–59.29806496
[8] Fan X Deng H Wang XQ . Association of red blood cell distribution width with severity of hepatitis B virus-related liver diseases. Clin Chim Acta. 2018;482 :155–60.29627486
[9] Zheng ZM He N Xu Z . Analysis of anxiety and depression and influencing factors of patients with chronic hepatitis B virus infection. Chin J Gen Prac. 2020;18 :1134–8.
[10] Wang YY Qian XY Ju LL Sun Y Qin G . Investigation and analysis of negative emotions in patients with decompensated HBV cirrhosis. Chin J Mod Nurs. 2017;23 :3400–04.
[11] Huang XY Zhang HY Qu C Liu Y Bian C Xu YH . Depression and insomnia are closely associated with thyroid hormone levels in chronic hepatitis B. Med Sci Monit. 2019;25 :2672–8.30973843
[12] Yao CP . Yellow emperor’s classic of internal medicine. Beijing: Zhonghua Book Company, 2022.
[13] Yang T Wang SR Wang RR . Effectiveness of five-element music therapy in cancer patients: a systematic review and meta-analysis. Complement Ther Clin Pract. 2021;44 :101416.34020291
[14] Wu XJ Deng YM Chi XL . Clinical observation of five elements music therapy combined with acupuncture in the treatment of chronic liver disease with insomnia of liver stagnation and spleen deficiency type. Chin J Integr Tradit West Med Liver Dis. 2021;31 :886–9.
[15] Zuo Y . A Study on Chinese medicine five-element music therapy for alopecia areata induced by hepatic Qi stagnation (depression). Hubei University of Chinese Medicine. 2015;12 :35.
[16] Liu L Wang CY Wang HL . Influence of five elements music on depression, nerve function and amino acid neurotransmitters in patients with post-stroke subthreshold depression. Chin Nurs Rese. 2022;37 :1460–4.
[17] Luo Y Chen SZ Shao L . Effects of Baduanjin combined with Wuxing music on anxiety and depression in patients with breast cancer chemotherapy. Chin Comm Doctors. 2021;37 :180–1.
[18] Hepatology Branch of Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis. Chin J Hepatol. 2019;27 :20.
[19] Jia HX Li X Yin DQ . Expert consensus on TCM syndrome differentiation and classification and quantitative grading standards for generalized anxiety disorder. J Tradit Chin Med. 2022;63 :1096–100.
[20] Zung WW . A self-rating depression scale. Arch Gen Psychiatry. 1965;12 :63–70.14221692
[21] Zung WW . A rating instrument for anxiety disorders. Psychosomatics. 1971;12 :371–9.5172928
[22] T/CRHA 036-2024. Nursing norms for the application of five-elements music therapy. Beijing: Chinese Society of Research Hospitals, 2024.
[23] Zhao SJ Wang MM Yang ZY . Comparison between Child-Pugh score and Albumin-Bilirubin grade in the prognosis of patients with HCC after liver resection using time-dependent ROC. Ann Transl Med. 2020;8 :539.32411762
[24] Zhang Z . Handbook of behavioral medicine scales. Beijing: Office of Chinese Journal of Behavioral Medical Science. 2001; 223–4.
[25] Zung WW . The depression status inventory: an adjunct to the Self-Rating Depression Scale. J Clin Psychol. 1972;28 :539–43.5080837
[26] Gabrys JB Peters K . Reliability, discriminant and predictive validity of the Zung Self-rating Depression Scale. Psychol Rep. 1091;57 :1091–6.
[27] Zhang Z . Handbook of behavioral medicine scales. Beijing: Office of Chinese Journal of Behavioral Medical Science. 2001; 213–4.
[28] Ismail NH Nik Jaafar NR Woon LS Mohd Ali M Dahlan R Baharuddin ANAP . Psychometric properties of the Malay-version beck anxiety inventory among adolescent students in Malaysia. Front Psychiatry. 2023;13 :989079.36762292
[29] Crider K Williams J Qi YP . Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas. Cochrane Database Syst Rev. 2022;2 :CD014217.36321557
[30] Lin ST Yang P Lai CY . Mental health implications of music: insight from neuroscientific and clinical studies. Harv Rev Psychiatry. 2011;19 :34–46.21250895
[31] Yu XH Qi XH . The use of five kinds of traditional Chinese medicine psychological disorder in guidance of music therapy in the treatment of insomnia. J Zhejiang Chin Med Univ. 2014;38 :28–30.
[32] Zhou J Chen J Wang J . Investigation and analysis of factoring affecting quality of life in patients with HBV cirrhosis. J Clin Nurs Practicality. 2013;17 :39–41, 44.
[33] Kwon CY Kim H Kim SH . The modernization of oriental music therapy: five-element music therapy combined with Artificial Intelligence. Healthcare (Basel). 2024;12 :411.38338296
[34] Sun YZ Wang SL Yu TY . Tiaoshen acupuncture method combined with electroacupuncture for diarrhea-type irritable bowel syndrome: a randomized controlled trial]. Chin Acupunct Moxibus. 2021;41 :13–6.
[35] Wu Q Liu ZJ Pang XL Cheng L . Efficacy of five-element music interventions in perinatal mental health and labor pain: a meta-analysis. Complement Ther Clin Pract. 2020;40 :101217.32763833
[36] Lin FC Gu YH Wu YC Huang DH He NN . Effect of music therapy derived from the five elements in Traditional Chinese Medicine on post-stroke depression. J Tradit Chin Med. 2017;37 :675–80.32188229
[37] Niu JF Zhao XF Hu HT Wang JJ Liu YL Lu DH . Should acupuncture, biofeedback, massage, Qi gong, relaxation therapy, device-guided breathing, yoga and tai chi be used to reduce blood pressure? Recommendations based on high-quality systematic reviews. Cosmplement Ther Med. 2019;42 :322–31.
[38] Hu L . The effect of five-elemen bmusic therapy on the quality of life in patients with liver stagnation and spleen deficiency and compensated HBV cirrhosis. J Shanghai Univ Tradit Chin Med. 2019;8 :15.
[39] Dan YQ Wang JH Ding Y . The potential mechanism for five-element music intervention of post-stroke depression: β-endorphin/μ opioid receptor system. Chin J Health Psychol. 2024;32 :358–64.
[40] Li Z Lin FC . Discussion on five-element music therapy based on the theory of the original image of the universe. Chin J Tradit Chin Med Pharm. 2022;37 :6115–9.
