针刺配合耳针治疗心肾不交型女性更年期失眠症的临床研究
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摘要
目的:观察针刺配合耳针治疗心肾不交型女性更年期失眠症的临床疗效。方法:将收集的心肾不交型女性更年期失眠症患者随机分为治疗组55例和对照组56例。对照组针刺神门、三阴交、安眠、照海、申脉、四神聪、心俞、肾俞,治疗组在对照组基础上加耳针治疗,取耳穴的肾、神门、交感、内分泌,均每周治疗3次,隔日1次,6次为1个疗程,连续治疗3个疗程。治疗前后采用匹兹堡睡眠质量指数(PSQI)量表评定睡眠质量及效率,并于治疗前后判定中医证候变化。结果:与治疗前比较,两组睡眠质量及睡眠效率评分均降低(P<0.05),且治疗组较对照组降低更显著(P<0.05)。与治疗前比较,治疗后两组失眠多梦、五心烦热、心悸烦躁、疲乏健忘证候积分均显著降低(P<0.05),且治疗组各项积分(除疲乏健忘外)较对照组降低更显著(P<0.05);治疗后,与同组治疗前及对照组比较,治疗组头晕耳鸣、潮热盗汗证候积分显著降低(P<0.05)。对照组显效率为32.1%(18/56)、总有效率为82.1%(46/56),治疗组显效率为54.5%(30/55)、总有效率为94.5%(52/55),治疗组均显著优于对照组(P<0.05)。结论:针刺配合耳针治疗心肾不交型女性更年期失眠症在症状评分、临床疗效等方面改善明显,比单用体针疗效更佳。
Objective To observe the therapeutic effect of body acupuncture combined with auricular acupuncture in the treatment of woman menopause insomnia induced by disharmony between the heart and kidney.Methods A total of 111 outpatients with menopausal insomnia were randomly divided into treatment group(n=55,body acupoints plus auricular points)and control group(n=56,body acupoints).For control group,Shenmen(HT7),Sanyinjiao(SP6),Anmian,Zhaohai(KI6),Shenmai(BL62),Sishencong(EX-HN1),Xinshu(BL15)and Shenshu(BL21)were needled with filiform needles,and HT7,SP6,Anmian,BL15 and BL21 were also stimulated with electroacupuncture(EA)for 30 min,once every other day,3 times a week for 3 weeks.For the treatment group,auricular points as Kidney,Shenmen,Sympathetic and Endocrine around the ear canal and the ear cavity were punctured with filiform needles in combination with the same intervention methods mentioned above in the control group.The quality and efficiency of sleep were assessed by using Pittsburgh Sleep Quality Index(PSQI)scale before and after the treatment.The symptom scores of traditional Chinese medicine(TCM)and the therapeutic effect were determined according to the "Guide Principles for Clinical Research of New Drugs of TCM"(formulated by Chinese Ministry of Health,1997).Results After the treatment,the scores of sleep quantity and effective rate of PSQI scale,and those of insomnia and dreaminess,dysphoria with feverish sensation in chest,palms and soles,paplpitation and irritability,fatigue and forgetfulness of TCM were reduced significantly in both groups compared with their own pre-treatment(P<0.05).Of the 56 and 55 cases in the control and treatment groups,18(32.1%)and 30(54.5%)experienced a marked improvement in their symptoms,28(50.0%)and 22(40.0%)were effective,and 10(17.9%)and 3(5.5%)failed,with the effective rate being 82.1% and94.5%,respectively.The therapeutic effect of stimulation of the body acupoints plus auricular acupoints was significantly superior to that of stimulation of simple body acupoints in lowering scores of PSQI scale,insomnia and dreaminess,dysphoria with feverish sensation in chest,palms and soles,dizziness and tinninus,paplpitation and irritability,and tital fever and night sweating of TCM,as well as the effective rate(P<0.05).Conclusion Both body acupuncture and body acupuncture combined with auricular acupuncture are effective in the treatment of woman menopause insomnia due to disharmony between the heart and kidney,and the two combined treatment was evidently better.
Objective To observe the therapeutic effect of body acupuncture combined with auricular acupuncture in the treatment of woman menopause insomnia induced by disharmony between the heart and kidney.Methods A total of 111 outpatients with menopausal insomnia were randomly divided into treatment group(n=55,body acupoints plus auricular points)and control group(n=56,body acupoints).For control group,Shenmen(HT7),Sanyinjiao(SP6),Anmian,Zhaohai(KI6),Shenmai(BL62),Sishencong(EX-HN1),Xinshu(BL15)and Shenshu(BL21)were needled with filiform needles,and HT7,SP6,Anmian,BL15 and BL21 were also stimulated with electroacupuncture(EA)for 30 min,once every other day,3 times a week for 3 weeks.For the treatment group,auricular points as Kidney,Shenmen,Sympathetic and Endocrine around the ear canal and the ear cavity were punctured with filiform needles in combination with the same intervention methods mentioned above in the control group.The quality and efficiency of sleep were assessed by using Pittsburgh Sleep Quality Index(PSQI)scale before and after the treatment.The symptom scores of traditional Chinese medicine(TCM)and the therapeutic effect were determined according to the "Guide Principles for Clinical Research of New Drugs of TCM"(formulated by Chinese Ministry of Health,1997).Results After the treatment,the scores of sleep quantity and effective rate of PSQI scale,and those of insomnia and dreaminess,dysphoria with feverish sensation in chest,palms and soles,paplpitation and irritability,fatigue and forgetfulness of TCM were reduced significantly in both groups compared with their own pre-treatment(P<0.05).Of the 56 and 55 cases in the control and treatment groups,18(32.1%)and 30(54.5%)experienced a marked improvement in their symptoms,28(50.0%)and 22(40.0%)were effective,and 10(17.9%)and 3(5.5%)failed,with the effective rate being 82.1% and94.5%,respectively.The therapeutic effect of stimulation of the body acupoints plus auricular acupoints was significantly superior to that of stimulation of simple body acupoints in lowering scores of PSQI scale,insomnia and dreaminess,dysphoria with feverish sensation in chest,palms and soles,dizziness and tinninus,paplpitation and irritability,and tital fever and night sweating of TCM,as well as the effective rate(P<0.05).Conclusion Both body acupuncture and body acupuncture combined with auricular acupuncture are effective in the treatment of woman menopause insomnia due to disharmony between the heart and kidney,and the two combined treatment was evidently better.
引文
[1]陈贵珍,许云祥,李沛.针灸治疗女性更年期综合征研究思路[J].中国针灸,2002,22(8):559-562.
[2]KARAAM Z,SEKER S E.Factors associated with menopausal symptoms and their relationship with the quality of life among Turkish women[J].Maturitas,2007,58(1):75-82.
[3]JOKINEN K,RAUTAVA P,MKINEN J,et al.Experience of climacteric symptoms among42-46 and 52-56-year-old women[J].Maturitas,2003,46(3):199-205.
[4]CHEDRAUI P,AGUIRRE W,HIDALGO L,et al.Assessing menopausal symptoms among healthy middle aged women with the Menopause Rating Scale[J].Maturitas,2007,57(3):271-278.
[5]蔡彩香,赵小萍,徐春英.40岁以上在职妇女更年期症状调查[J].现代预防医学,1999,26(1):73-74.
[6]周晓琼.针刺配合耳穴贴压治疗失眠疗效观察[J].浙江中西医结合杂志,2013,23(10):808-809.
[7]佀雪平,吕文静,陈晶晶,等.针刺配合耳穴贴压治疗阴虚火旺型围绝经期失眠症38例临床观察[J].中医药学报,2013,41(5):120-121.
[8]BRZEZINSKI A.Melatonin in humans[J].N Engl J Med,1997,336(3):186-195.
[9]MUTOH T,SHIBATA S,KORF H W,et al.Melatonin modulates the light-induced sympathoexcitation and vagal suppression with participation of the suprachiasmatic nucleus in mice[J].J Physiol,2003,547(1):317-332.
[10]HAUS E L,SMOLENSKY MH.Shift work and cancer risk:potential mechanistic roles of circadian disruption,light at night,and sleep deprivation[J].Sleep Med Rev,2013,17(4):273-284.
[11]乐杰.妇产科学[M].6版.北京:人民卫生出版社,2004.
[12]中华医学会精神科分会.CCMD-3中国精神障碍分类与诊断标准[M].3版.济南:山东科学技术出版社,2001.
[13]陈佑邦.中医病症诊断疗效标准[S].南京:南京大学出版社,1994:175.
[14]中华人民共和国卫生部.中药新药临床研究指导原则[S].北京:人民卫生出版社,1997.
[15]崔亚美,阮祥燕,田玄玄,等.北京妇产医院就诊妇女更年期症状发生率的调查研究[J].首都医科大学学报,2014,35(4):392-396.
[16]胡艳梅.疏肝解郁法治疗女性更年期失眠临床疗效分析[J].亚太传统医药,2014,10(14):48-49.
[17]孙敬青,郭静,等.针刺治疗原发性失眠的文献质量评价[J].针刺研究,2010,35(2):151-155.
[18]张皓.针刺干预后更年期综合征患者临床症状及β-内啡肽的改变[J].中国临床康复,2006,10(31):1-3.
[19]曹庆淑.经穴-脏腑相关及其联系途径的研究[M].北京:人民卫生出版社,1990:154.
[20]董征.体表内脏相关论[M].北京:中国科技出版社,1992:10.
[21]严洁,朱兵.针灸的基础与临床[M].长沙:湖南科学技术出版社,2010:6.
[22]徐淑稳,茹秀丽,黄丽霞,等.中医针灸辅助治疗妇女更年期失眠效果分析[J].中国中医基础医学杂志,2014,20(1):106-108.
[23]赵敬军,李少源,焦玥,等.耳针治疗失眠的研究现状[J].针灸临床杂志,2014,30(9):82-85.
[24]高昕妍,荣培晶,朱兵.耳针对心血管和胃运动的调节及其机制[J].中国针灸,2005,25(S1):48-49.
[2]KARAAM Z,SEKER S E.Factors associated with menopausal symptoms and their relationship with the quality of life among Turkish women[J].Maturitas,2007,58(1):75-82.
[3]JOKINEN K,RAUTAVA P,MKINEN J,et al.Experience of climacteric symptoms among42-46 and 52-56-year-old women[J].Maturitas,2003,46(3):199-205.
[4]CHEDRAUI P,AGUIRRE W,HIDALGO L,et al.Assessing menopausal symptoms among healthy middle aged women with the Menopause Rating Scale[J].Maturitas,2007,57(3):271-278.
[5]蔡彩香,赵小萍,徐春英.40岁以上在职妇女更年期症状调查[J].现代预防医学,1999,26(1):73-74.
[6]周晓琼.针刺配合耳穴贴压治疗失眠疗效观察[J].浙江中西医结合杂志,2013,23(10):808-809.
[7]佀雪平,吕文静,陈晶晶,等.针刺配合耳穴贴压治疗阴虚火旺型围绝经期失眠症38例临床观察[J].中医药学报,2013,41(5):120-121.
[8]BRZEZINSKI A.Melatonin in humans[J].N Engl J Med,1997,336(3):186-195.
[9]MUTOH T,SHIBATA S,KORF H W,et al.Melatonin modulates the light-induced sympathoexcitation and vagal suppression with participation of the suprachiasmatic nucleus in mice[J].J Physiol,2003,547(1):317-332.
[10]HAUS E L,SMOLENSKY MH.Shift work and cancer risk:potential mechanistic roles of circadian disruption,light at night,and sleep deprivation[J].Sleep Med Rev,2013,17(4):273-284.
[11]乐杰.妇产科学[M].6版.北京:人民卫生出版社,2004.
[12]中华医学会精神科分会.CCMD-3中国精神障碍分类与诊断标准[M].3版.济南:山东科学技术出版社,2001.
[13]陈佑邦.中医病症诊断疗效标准[S].南京:南京大学出版社,1994:175.
[14]中华人民共和国卫生部.中药新药临床研究指导原则[S].北京:人民卫生出版社,1997.
[15]崔亚美,阮祥燕,田玄玄,等.北京妇产医院就诊妇女更年期症状发生率的调查研究[J].首都医科大学学报,2014,35(4):392-396.
[16]胡艳梅.疏肝解郁法治疗女性更年期失眠临床疗效分析[J].亚太传统医药,2014,10(14):48-49.
[17]孙敬青,郭静,等.针刺治疗原发性失眠的文献质量评价[J].针刺研究,2010,35(2):151-155.
[18]张皓.针刺干预后更年期综合征患者临床症状及β-内啡肽的改变[J].中国临床康复,2006,10(31):1-3.
[19]曹庆淑.经穴-脏腑相关及其联系途径的研究[M].北京:人民卫生出版社,1990:154.
[20]董征.体表内脏相关论[M].北京:中国科技出版社,1992:10.
[21]严洁,朱兵.针灸的基础与临床[M].长沙:湖南科学技术出版社,2010:6.
[22]徐淑稳,茹秀丽,黄丽霞,等.中医针灸辅助治疗妇女更年期失眠效果分析[J].中国中医基础医学杂志,2014,20(1):106-108.
[23]赵敬军,李少源,焦玥,等.耳针治疗失眠的研究现状[J].针灸临床杂志,2014,30(9):82-85.
[24]高昕妍,荣培晶,朱兵.耳针对心血管和胃运动的调节及其机制[J].中国针灸,2005,25(S1):48-49.