火针五脏俞加膈俞配合毫针治疗慢性失眠症临床疗效观察
|
摘要
背景慢性失眠症影响人们的工作和生活,增加罹患疾病的风险,降低患者工作效率以及引发意外事故造成巨大损失。目前对于慢性失眠症治疗仍以苯二氮卓类药物为主,长期大剂量使用会出现对此类药物反应性下降。五脏藏神,人的精神情志与五脏密切相关,五脏失调可以导致失眠,通过针刺五脏俞可以调和阴阳、调整脏腑功能。目的探讨火针五脏俞加膈俞配合毫针治疗慢性失眠症的临床疗效。方法选取2016年11月——2017年10月北京中医医院顺义医院针灸科收治的60例慢性失眠症患者为研究对象,采用随机数字表法分为火针组和毫针组,各30例。毫针组给予毫针针刺百会、四神聪、神门、三阴交等穴,1次/d,5次/周;火针组在毫针组基础上选取双侧五脏俞加膈俞,予贺氏火针点刺,隔日治疗1次,3次/周;两组均连续治疗4周。评定两组临床疗效,分别于治疗前、治疗4周时及治疗结束后1个月进行匹兹堡睡眠质量指数(PSQI)评分、焦虑自评量表(SAS)评分和抑郁自评量表(SDS)评分。结果治疗后,火针组临床痊愈7例、显效12例、有效9例、无效2例;毫针组临床痊愈3例、显效9例、有效11例、无效7例;火针组临床疗效优于毫针组(Z=-2.152,P=0.031)。治疗方法与时间在PSQI评分、SAS评分、SDS评分上存在交互作用(P<0.05),治疗方法在PSQI评分、SAS评分、SDS评分上主效应显著(P<0.05),时间在PSQI评分、SAS评分、SDS评分上主效应显著(P<0.05)。其中治疗前两组患者PSQI评分、SAS评分、SDS评分比较,差异无统计学意义(P>0.05);治疗4周及治疗结束后1个月火针组PSQI评分、SAS评分、SDS评分较毫针组降低(P<0.05)。火针组和毫针组治疗4周及治疗结束后1个月PSQI评分、SAS评分、SDS评分较治疗前降低(P<0.05)。结论火针五脏俞加膈俞配合毫针针刺治疗能更有效地改善慢性失眠症患者的睡眠质量,临床疗效优于单纯毫针治疗。
Background Chronic insomnia affects people's work and life,increases the risk of having disease,reduces work efficiency of patients and causes huge losses of accidents.At present,benzodiazepines are still the main treatment for chronic insomnia.Long-term and high-dose use of benzodiazepines will significantly reduce the responsiveness of these drugs.As human organs can affect people's spirit,viscera function disorder can lead to insomnia.Acupuncturing on Wuzangshu acupoint can adjust Yin and Yang and viscera function.Objective To investigate the clinical efficacy of acupuncture at Wuzangshu combined Geshu acupoints with fire needles and filiform needles in the treatment of chronic insomnia.Methods We enrolled 60 cases of chronic insomnia treated in Beijing Shunyi District Hospital of Traditional Chinese Medicine from November 2016 to October 2017,and divided them into fire needle group(n=30) and filiform needle group(n=30) based on the random number table.Both groups received treatment of acupuncture at Baihui,Sishencong,Shenmen,Sanyinjiao and other acupoints with filiform needles,once daily,5 times a week,the fire needle group additionally received acupuncture at Wuzangshu combined Geshu acupoints with fire needles(developed by HE Pu-ren),once every other day,3 times a week.The duration of treatment for both groups was 4 weeks.The clinical response was evaluated at the end of treatment and 1 month after the end of treatment by the Pittsburgh Sleep Quality Index(PSQI),Zung Self-Rating Anxiety Scale(SAS) score,and Zung Self-Rating Depression Scale(SDS) score.Results In the fire needle group,7,12,9,2 showed complete,marked,effective,and ineffective clinical response,respectively,while in the filiform needle group,3,9,11,7 showed complete,marked,effective,and ineffective clinical response,respectively,indicating that the former had better clinical response(Z=-2.152,P=0.031).There was an interaction between treatment method and duration on total PSQI score,SAS score,SDS score(P<0.05).Treatment method produced significant main effects on total PSQI score,SAS score,and SDS score(P<0.05),so did the treatment duration.Total PSQI score,SAS score,and SDS score were similar in both groups before treatment,but they decreased significantly in the fire needle group at the end of treatment and 1 month after the end of treatment(P<0.05). PSQI score,SAS score,and SDS score in the fire needle group at the end of treatment and 1 month after the end of treatment declined significantly compared with baseline(P<0.05). Conclusion For chronic insomnia,acupuncture at Baihui,Sishencong,Shenmen,Sanyinjiao and other acupoints with filiform needles was inferior to its combination with acupuncture at Wuzangshu combined Geshu acupoints with fire needles and filiform needles.
Background Chronic insomnia affects people's work and life,increases the risk of having disease,reduces work efficiency of patients and causes huge losses of accidents.At present,benzodiazepines are still the main treatment for chronic insomnia.Long-term and high-dose use of benzodiazepines will significantly reduce the responsiveness of these drugs.As human organs can affect people's spirit,viscera function disorder can lead to insomnia.Acupuncturing on Wuzangshu acupoint can adjust Yin and Yang and viscera function.Objective To investigate the clinical efficacy of acupuncture at Wuzangshu combined Geshu acupoints with fire needles and filiform needles in the treatment of chronic insomnia.Methods We enrolled 60 cases of chronic insomnia treated in Beijing Shunyi District Hospital of Traditional Chinese Medicine from November 2016 to October 2017,and divided them into fire needle group(n=30) and filiform needle group(n=30) based on the random number table.Both groups received treatment of acupuncture at Baihui,Sishencong,Shenmen,Sanyinjiao and other acupoints with filiform needles,once daily,5 times a week,the fire needle group additionally received acupuncture at Wuzangshu combined Geshu acupoints with fire needles(developed by HE Pu-ren),once every other day,3 times a week.The duration of treatment for both groups was 4 weeks.The clinical response was evaluated at the end of treatment and 1 month after the end of treatment by the Pittsburgh Sleep Quality Index(PSQI),Zung Self-Rating Anxiety Scale(SAS) score,and Zung Self-Rating Depression Scale(SDS) score.Results In the fire needle group,7,12,9,2 showed complete,marked,effective,and ineffective clinical response,respectively,while in the filiform needle group,3,9,11,7 showed complete,marked,effective,and ineffective clinical response,respectively,indicating that the former had better clinical response(Z=-2.152,P=0.031).There was an interaction between treatment method and duration on total PSQI score,SAS score,SDS score(P<0.05).Treatment method produced significant main effects on total PSQI score,SAS score,and SDS score(P<0.05),so did the treatment duration.Total PSQI score,SAS score,and SDS score were similar in both groups before treatment,but they decreased significantly in the fire needle group at the end of treatment and 1 month after the end of treatment(P<0.05). PSQI score,SAS score,and SDS score in the fire needle group at the end of treatment and 1 month after the end of treatment declined significantly compared with baseline(P<0.05). Conclusion For chronic insomnia,acupuncture at Baihui,Sishencong,Shenmen,Sanyinjiao and other acupoints with filiform needles was inferior to its combination with acupuncture at Wuzangshu combined Geshu acupoints with fire needles and filiform needles.
引文
[1]SHEKLETON J A,ROGERS N L,RAJARATNAM S M.Searching for the daytime impairments of primary insomnia[J].Sleep Med Rev,2010,14(1):47-60.DOI:10.1016/j.smrv.2009.06.001.
[2]ABE Y.Fatigue as a core symptom of insomnia[J].Innov Clin Neurosci,2012,9(2):10-11.
[3]洪秋阳,王世产,杨怡,等.针刺导气法配合放血治疗原发性失眠疗效观察[J].针灸临床杂志,2016,32(10):35-37.HONG Q Y,WANG S C,YANG Y,et al.Acupuncture gas guide method combined with bloodletting treatment of primary insomnia efficacy[J].Journal of Clinical Acupuncture and Moxibustion,2016,32(10):35-37.
[4]美国精神医学学会.精神障碍诊断与统计手册(第五版):DSM-5[M].张道龙,译.北京:北京大学出版社,2015.American Psychiatric Association.The diagnostic and statistical manual of mental disorders,fifth edition[M].CHEN D L,translator.Beijing:Peking University Press,2015.
[5]国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:31-32.
[6]高树中,杨骏.针灸治疗学[M].北京:中国中医药出版社,2016:75-76.
[7]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002.
[8]BACKHAUS J,JUNQHANNS K,BROOCKS A,et al.Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia[J].J Psychosom Res,2002,53(3):734-740.
[9]BUYSSE D J.Insomnia[J].JAMA,2013,309(7):706-716.DOI:10.1001/jama.2013.193.
[10]REDDY M S,ARINDAM C.“Comorbid”insomnia[J].Indian J Psychol Md,2011,33(1):1-4.DOI:10.4103/0253-7176.85394.
[11]NAKAZAKI C,NODA A,KOIKE Y,et al.Association of insomnia and short sleep duration with atherosclerosis risk in the elderly[J].Am J Hypertens,2012,25(11):1149-1155.DOI:10.1038/ajh.2012.107.
[12]奎瑜,陈秀华,徐振华,等.陈氏飞针治疗椎动脉型颈椎病伴失眠的临床研究[J].中国全科医学,2016,19(21):2553-2556,2561.DOI:10.3969/j.issn.1007-9572.2016.21.012.KUI Y,CHEN X H,XU Z H,et al.Clinical study on Chen’s Flying acupuncture in the treatment of insomnia combined with vertebral artery type of cervical spondylosis[J].Chinese General Practice,2016,19(21):2553-2556,2561.DOI:10.3969/j.issn.1007-9572.2016.21.012.
[13]马艳苗,贾跃进,柴智,等.浅述中西医对失眠症昼夜节律的认识[J].世界中西医结合杂志,2017,12(9):1189-1191.DOI:10.13935/j.cnki.sjzx.170902.MA Y M,JIA Y J,CHAI Z,et al.Recognition on the circadian rhythm of integrated Chinese and Western Medicine in insomnia[J].World Journal of Integrated Traditional and Western Medicine,2017,12(9):1189-1191.DOI:10.13935/j.cnki.sjzx.170902.
[14]田永衍,王庆其.《黄帝内经》睡眠病证治概论[J].中华中医药杂志,2015,30(9):3239-3241.TIAN Y Y,WANG Q Q.Overview of syndromes and therapies of sleeping sickness in Inner Cannon of Huangdi[J].China Journal of Traditional Chinese Medicine and Pharmacy,2015,30(9):3239-3241.
[15]陈湘生,张俊英.金针王乐亭经验集[M].北京:人民卫生出版社,2004:125-128.
[16]杨茜,方庆霞.针刺五脏俞加膈俞为主穴辨证治疗慢性失眠患者70例临床观察[J].中医杂志,2015,56(20):1760-1762.DOI:10.13288/j.11-2166/r.2015.20.013.YANG Q,FANG Q X.Clinical observation on acupuncture with Shu-points of Five-organs and Point Geshu(BL17)as main points in treating 70 cases of chronic insomnia according to different syndromes[J].Journal of Traditional Chinese Medicine,2015,56(20):1760-1762.DOI:10.13288/j.11-2166/r.2015.20.013.
[17]王莒生,王麟鹏,程金莲.中国百年百名中医临床家丛书--王乐亭[M].北京:中国中医药出版社,2005:199-202.
[18]洪秋阳,杨惠民,王世广,等.灵龟八法结合火针针刺对心脾两虚型失眠患者觉醒状态的影响[J].针灸临床杂志,2017,33(8):26-30.HONG Q Y,YANG H M,WANG S G,et al.Effect of Ling Gui Ba Fa combined with fire needling on daytime arousal of patients with insomnia due to heart-spleen deficiency[J].Journal of Clinical Acupuncture and Moxibustion,2017,33(8):26-30.
[19]ROTH T,HAJAK G,USTüN T B,et al.Consensus for the pharmacological management of insomnia in the new millerniurn[J].Int J Clin Pract,2001,55(1):42-52.
[20]徐碧云,李艳,欧碧阳,等.心理应激性失眠患者焦虑抑郁情绪分析[J].中国康复,2009,23(1):47-48.DOI:10.3870/zgkf.2009.01.023.XU B Y,LI Y,OU B Y,et al.Analysis of anxiety and depression in patients with psychological stress insomnia[J].Chinese Journal of Rehabilitation,2009,23(1):47-48.DOI:10.3870/zgkf.2009.01.023.
[21]SPIRA A P,FRIEDMAN L,AULAKH J S,et al.Subclinical anxiety symptoms,sleep,and daytime dysfunction in older adults with primary insomnia[J].J Geriatr Psychiatry Neurol,2008,6(21):149-153.DOI:10.1177/0891988707317120.
[22]徐世芬,庄礼兴,唐纯志,等.针刺与埋线干预对抑郁大鼠中枢单胺类神经递质的影响[J].中国针灸,2007,27(6):435-437.XU S F,ZHUANG L X,TANG C Z,et al.Effects of acupuncture and embedding thread on central monoamine neurotransmitters in the depression model rat[J].Chinese Acupuncture and Moxibustion,2007,27(6):435-437.
[23]迟旭.针刺中渚穴的脑功能性磁共振成像研究[J].中医药学报,2009,37(1):37-38.DOI:10.3969/j.issn.1002-2392.2009.01.015.CHI X.Study on cerebral functional magnetic resonance imaging in acupuncture at acupoints[J].Acta Chinese Medicine and Pharmacology,2009,37(1):37-38.DOI:10.3969/j.issn.1002-2392.2009.01.015.
[2]ABE Y.Fatigue as a core symptom of insomnia[J].Innov Clin Neurosci,2012,9(2):10-11.
[3]洪秋阳,王世产,杨怡,等.针刺导气法配合放血治疗原发性失眠疗效观察[J].针灸临床杂志,2016,32(10):35-37.HONG Q Y,WANG S C,YANG Y,et al.Acupuncture gas guide method combined with bloodletting treatment of primary insomnia efficacy[J].Journal of Clinical Acupuncture and Moxibustion,2016,32(10):35-37.
[4]美国精神医学学会.精神障碍诊断与统计手册(第五版):DSM-5[M].张道龙,译.北京:北京大学出版社,2015.American Psychiatric Association.The diagnostic and statistical manual of mental disorders,fifth edition[M].CHEN D L,translator.Beijing:Peking University Press,2015.
[5]国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:31-32.
[6]高树中,杨骏.针灸治疗学[M].北京:中国中医药出版社,2016:75-76.
[7]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002.
[8]BACKHAUS J,JUNQHANNS K,BROOCKS A,et al.Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia[J].J Psychosom Res,2002,53(3):734-740.
[9]BUYSSE D J.Insomnia[J].JAMA,2013,309(7):706-716.DOI:10.1001/jama.2013.193.
[10]REDDY M S,ARINDAM C.“Comorbid”insomnia[J].Indian J Psychol Md,2011,33(1):1-4.DOI:10.4103/0253-7176.85394.
[11]NAKAZAKI C,NODA A,KOIKE Y,et al.Association of insomnia and short sleep duration with atherosclerosis risk in the elderly[J].Am J Hypertens,2012,25(11):1149-1155.DOI:10.1038/ajh.2012.107.
[12]奎瑜,陈秀华,徐振华,等.陈氏飞针治疗椎动脉型颈椎病伴失眠的临床研究[J].中国全科医学,2016,19(21):2553-2556,2561.DOI:10.3969/j.issn.1007-9572.2016.21.012.KUI Y,CHEN X H,XU Z H,et al.Clinical study on Chen’s Flying acupuncture in the treatment of insomnia combined with vertebral artery type of cervical spondylosis[J].Chinese General Practice,2016,19(21):2553-2556,2561.DOI:10.3969/j.issn.1007-9572.2016.21.012.
[13]马艳苗,贾跃进,柴智,等.浅述中西医对失眠症昼夜节律的认识[J].世界中西医结合杂志,2017,12(9):1189-1191.DOI:10.13935/j.cnki.sjzx.170902.MA Y M,JIA Y J,CHAI Z,et al.Recognition on the circadian rhythm of integrated Chinese and Western Medicine in insomnia[J].World Journal of Integrated Traditional and Western Medicine,2017,12(9):1189-1191.DOI:10.13935/j.cnki.sjzx.170902.
[14]田永衍,王庆其.《黄帝内经》睡眠病证治概论[J].中华中医药杂志,2015,30(9):3239-3241.TIAN Y Y,WANG Q Q.Overview of syndromes and therapies of sleeping sickness in Inner Cannon of Huangdi[J].China Journal of Traditional Chinese Medicine and Pharmacy,2015,30(9):3239-3241.
[15]陈湘生,张俊英.金针王乐亭经验集[M].北京:人民卫生出版社,2004:125-128.
[16]杨茜,方庆霞.针刺五脏俞加膈俞为主穴辨证治疗慢性失眠患者70例临床观察[J].中医杂志,2015,56(20):1760-1762.DOI:10.13288/j.11-2166/r.2015.20.013.YANG Q,FANG Q X.Clinical observation on acupuncture with Shu-points of Five-organs and Point Geshu(BL17)as main points in treating 70 cases of chronic insomnia according to different syndromes[J].Journal of Traditional Chinese Medicine,2015,56(20):1760-1762.DOI:10.13288/j.11-2166/r.2015.20.013.
[17]王莒生,王麟鹏,程金莲.中国百年百名中医临床家丛书--王乐亭[M].北京:中国中医药出版社,2005:199-202.
[18]洪秋阳,杨惠民,王世广,等.灵龟八法结合火针针刺对心脾两虚型失眠患者觉醒状态的影响[J].针灸临床杂志,2017,33(8):26-30.HONG Q Y,YANG H M,WANG S G,et al.Effect of Ling Gui Ba Fa combined with fire needling on daytime arousal of patients with insomnia due to heart-spleen deficiency[J].Journal of Clinical Acupuncture and Moxibustion,2017,33(8):26-30.
[19]ROTH T,HAJAK G,USTüN T B,et al.Consensus for the pharmacological management of insomnia in the new millerniurn[J].Int J Clin Pract,2001,55(1):42-52.
[20]徐碧云,李艳,欧碧阳,等.心理应激性失眠患者焦虑抑郁情绪分析[J].中国康复,2009,23(1):47-48.DOI:10.3870/zgkf.2009.01.023.XU B Y,LI Y,OU B Y,et al.Analysis of anxiety and depression in patients with psychological stress insomnia[J].Chinese Journal of Rehabilitation,2009,23(1):47-48.DOI:10.3870/zgkf.2009.01.023.
[21]SPIRA A P,FRIEDMAN L,AULAKH J S,et al.Subclinical anxiety symptoms,sleep,and daytime dysfunction in older adults with primary insomnia[J].J Geriatr Psychiatry Neurol,2008,6(21):149-153.DOI:10.1177/0891988707317120.
[22]徐世芬,庄礼兴,唐纯志,等.针刺与埋线干预对抑郁大鼠中枢单胺类神经递质的影响[J].中国针灸,2007,27(6):435-437.XU S F,ZHUANG L X,TANG C Z,et al.Effects of acupuncture and embedding thread on central monoamine neurotransmitters in the depression model rat[J].Chinese Acupuncture and Moxibustion,2007,27(6):435-437.
[23]迟旭.针刺中渚穴的脑功能性磁共振成像研究[J].中医药学报,2009,37(1):37-38.DOI:10.3969/j.issn.1002-2392.2009.01.015.CHI X.Study on cerebral functional magnetic resonance imaging in acupuncture at acupoints[J].Acta Chinese Medicine and Pharmacology,2009,37(1):37-38.DOI:10.3969/j.issn.1002-2392.2009.01.015.