针灸结合药物治疗抑郁症伴睡眠障碍的临床研究
|
摘要
本研究先阐述抑郁症是一种患病率高、复发率高及自杀率高的情绪障碍性疾病,表现为一种持久的抑郁状态,伴情绪低落、躯体不适和睡眠障碍等症状;抑郁症的临床表现可概括为心境低落、能力下降和躯体症状三个方面。
有61.8%的抑郁症患者首发症状为睡眠障碍,而没有睡眠障碍的抑郁症患者大约只占1%,睡眠障碍存在中至重度抑郁者分别为31%。睡眠障碍也可以加重抑郁症的病情,延缓抑郁症的康复进程,因此睡眠障碍的改善对抑郁症的缓解与康复必然有促进作用;睡眠障碍可作为抑郁症新的发作和再发的预测和防治指标,是预测和防治抑郁症的关键症状。
针灸治疗抑郁症研究已涉及神经内分泌、神经递质及其受体、免疫功能、神经信号传导通路等方面,此外,部分研究还涉及不同递质、脑内不同区域之间的平衡关系,有研究还关注了针灸对海马神经元细胞凋亡和保护的影响,研究发现,针灸治疗抑郁症的作用机制也与多个机制和过程有关。另外,已经有研究开始关注多个机制之间的关系,如中枢神经递质之间的关系,大脑不同区域组织和功能的比较,同一神经递质在中枢和外周之间的关系等。
本研究针灸介入选择性5-羟色胺再摄取抑制剂(SSRIs类抗抑郁药)治疗抑郁症伴睡眠障碍,可提高中医在治疗抑郁症中的作用与地位,拓宽临床治疗思路,为提高临床疗效、减少药物的副作用提供更为确切的方法。目前SSRIs类药物仍然存在一些无法克服的不足,例如起效延迟、副反应多,以及对躯体症状和心理症状作用有限,并需要3～6wk才能发挥其疗效,有效率仅在70%左右等问题。因此,寻求非药物疗法治疗本病具有广泛的应用前景及社会意义。
综上所述,针灸结合抗抑郁药是针灸发展的重要途径,它结合了针灸与药物的双重优势,拓宽了针灸治疗的病种,使针灸涉足到更多更新的领城。针灸结合抗抑郁药的方法在临床上愈来愈广泛地被应用,并显示出明显的优势。针灸可作为抑郁症伴睡眠障碍长期防治方法,对改善睡眠障碍、防治抑郁复发起着积极医疗效应。
目的:
(1)理论研究:
1.明确抑郁症是西医病名,虽然抑郁症的表现形式可在多种中医病名的症状群中出现,就目前来讲还不能将抑郁症直接等同于某一中医病名。
2.明确睡眠障碍泛指睡眠紊乱,包括中医的失眠及嗜睡。
3.探讨抑郁症、睡眠障碍西医发病机制。
4.许多文献研究显示西药治疗存在起效慢、副作用大、患者依从性差等不足。
5.分析针灸调整作用的整体性与西药作用比较单一的特点有显著差别。
6.探讨“脑为元神之府”理论指导抑郁伴睡眠障碍的针灸治疗优势。
7.明确针灸督脉为主经穴治疗这类病症的疗效与三环类药物相当,同时对诸如焦虑/躯体化等症状改善优于后者。
(2)临床研究:
观察抑郁症伴睡眠障碍的病患服食选择性5-羟色胺再摄取抑制剂(SSRIs类抗抑郁药)的同时,进行针刺督脉为主穴位加灸百会穴的针灸治疗组(治疗组),与单纯服用选择性5-羟色胺再摄取抑制剂(SSRIs类抗抑郁药),不进行针灸(对照组)的临床疗效,寻找治疗抑郁症睡眠障碍的有效方法;探讨针刺督脉为主穴位加灸百会穴在治疗抑郁症伴睡眠障碍患者的作用机理、以期开拓针灸防治疾病的多向性。为提高临床疗效、减少药物的副作用、提高患者生活质量提供确切方法。
方法:
(1)理论研究:
1.收集中医治疗抑郁、睡眠障碍文献进行分析、综述。
2.收集西医治疗抑郁、睡眠障碍文献进行分析、综述。
3.收集中西医结合治疗抑郁、睡眠障碍文献进行分析、综述。
4.综合上述资料说明针灸结合药物治疗治疗抑郁症伴睡眠障碍的重要性。
(2)临床研究
2006年9月～2008年12月选取60例新加坡KONG'S TCM＆新加坡育国中医诊疗所私人有限公司门诊病人(均由精神科医生诊断为抑郁症),随机分为2组,治疗组与对照组各30例。2组的病情、年龄等基本情况具有可比性。2组同样常规服食选择性5-羟色胺再摄取抑制剂(SSRIs类抗抑郁药)治疗组服食SSRIs类抗抑郁药同时针刺印堂、神庭、大椎、风池(双)、神门(双)、三阴交(双),灸百会,配合辨证取穴和随证加减,每周治疗二次,治疗2周作一次随访,治疗10周为一疗程。对照组只服食SSRIs类抗抑郁药不进行针灸,2周作一次随访,观察时间为10周。于治疗前、治疗第2周、第10周末观察治疗组与对照组之间的汉密尔顿(HAMD)量表、匹兹堡睡眠质量指数评定量表(PSQI)、自评抑郁量表(SDS)、Asberg副作用量表(SERS)、临床疗效总评量表(CGI)的变化。
结果:
(1)理论研究:
1.针灸督脉经穴可使中缝核内5-HT能神经元活动明显增加,黑质、下丘脑等处5-HT含量增加。并且可以改善脑部血液循环,提高脑组织抗氧化能力,改善记忆功能。
2.灸百会有调整阴阳、醒脑开窍、宁心安神之功。艾灸此穴能改善脑组织血液供应及血管弹性,并能通过大脑皮层的反射调节自主神经,进而对神经系统疾病起到治疗作用;艾灸百会穴能抑制脑的异常兴奋,使紊乱的脑功能恢复平衡、协调。
(2)临床研究:
经过10周治疗后,治疗组的汉密尔顿(HAMD)量表、自身前后对比有非常显着差异(P＜0.01);对照组自身前后对比有差异(P＜0.05),说明两种治疗方法对改善抑郁症患者汉密尔顿(HAMD)量表评分均有效,具有统计学意义。在治疗过程中(第2周),两种治疗方法相比对于改善汉密尔顿(HAMD)量表评分有差异(P＜0.05):在治疗结束时(第10周),两种治疗方法相比对于改善汉密尔顿(HAMD)量表评分则无差异(P＞0.05),提示此两种治疗方法相比虽然最终对于改善汉密尔顿(HAMD)量表评分无差异,但针灸治疗组的效果要快于药物组。
经过10周的治疗,针灸治疗组自身前后对比匹兹堡睡眠质量指数评定量表(PSQI)评分有非常显着差异(P＜0.01);药物对照组自身前后对比无差异(P＞0.05),说明针灸对改善抑郁症患者匹兹堡睡眠质量指数评定量表(PSQI)评分有效,具有统计学意义。在治疗过程中(第2周),两种治疗方法相比对于改善匹兹堡睡眠质量指数评定量表(PSQI)评分有差异(P＜0.05),提示针灸治疗组的效果要优于药物组。
经过10周的治疗,两组自身前后对比自评抑郁量表(SDS)评分均无差异(P＞0.05);说明这两种方法对抑郁症患者自评抑郁量表(SDS)评分的改善均无统计学意义。在治疗过程中(第2周),两种治疗方法相比对于改善自评抑郁量表(SDS)评分有差异(P＜0.05);在治疗结束时(第10周),两种治疗方法相比对于改善自评抑郁量表(SDS)评分则无差异(P＞0.05),提示此两种治疗方法相比虽然最终对于改善自评抑郁量表(SDS)评分无差别,但治疗组的效果要快于对照组。
经过10周的治疗,两组自身前后对比Asberg副作用量表(SERS)评分均无差异(P＞0.05);说明这两种方法对抑郁症患者Asberg副作用量表(SERS)评分的改善均无统计学意义。在治疗过程中(第2周),两种治疗方法相比对于改善Asberg副作用量表(SERS)评分有非常显着差异(P＜0.01);在治疗结束时(第10周),两种治疗方法相比对于改善Asberg副作用量表(SERS)评分亦有非常显着差异(P＜0.01),提示治疗组对于改善抑郁症Asberg副作用要优于对照组。
两组在病情严重程度(SI)上无差异(P＞0.05);经过10周的治疗,在疗效总评(GI)上治疗组优于对照组,有统计学意义(P＜0.05):在疗效指数(EI)上两组相比无差别(P＞0.05)。提示针灸结合SSRIs类药物对于抑郁症伴睡眠困难具有确切的疗效。
结论:
(1)理论研究:
1.针灸结合抗抑郁药的疗效优势主要体现在可以更好改善焦虑、睡眠障碍等躯体症状。
2.针灸结合抗抑郁药可以弥补抗抑郁药起效较慢问题,可以减轻西药副反应;临床已显示出起效快、疗效高的互补优势。
3.针灸作用的基础在刺激患者自身内源性调节机制的发挥,无须借助于药物而起作用,因而对人体不会有任何副作用。
4.文献表明单独的针刺治疗治疗抑郁症的显愈率为76.67%,而针灸结合抗抑郁药则更能明显提高显效率和总有效率。
5.针灸可以提高脑内单胺能神经系统功能,增加脑中特定部位5-HT、NE、DA含量,以改善抑郁症患者临床症状。
(2)临床研究:
1.针灸结合SSRIs类药物对于抑郁症具有确切的疗效,针灸可作为SSRIs类药物治疗抑郁症伴睡眠障碍的辅助疗法。
2.针灸结合药物治疗抑郁症伴睡眠障碍可以有效提高临床疗效,其优势主要体现在见效快,对抑郁症伴发的躯体症状和睡眠障碍的改善明显优于单纯使用SSRIs类药物。
3.针灸结合药物治疗抑郁症伴睡眠障碍能够减轻因药物的副作用所引起的各种症状。
Depression is a common illness in the modern world.It has a high rate of repetition and suicides,the patients remain in a prolonged state of depressed situation with symptoms of low spirit,physical discomfort and sleeping disorder.Depression can be generalized in three aspects: low spirit,sharp drop in ability and some physical symptoms.
Among the depression patients,there are 61.8%who start with the symptoms of sleeping disorder,only 1%of depression patients do not display sleeping disorder.31%of the medium to severe depression patients experience sleeping disorder.Sleeping disorder may worsen the depression and delay the recovery process.Thus,improvement of sleeping disorder is an advantage factor for alleviation and recovery of the depression patients.Sleeping disorder is a predictive factor of any depression relapse,it is also an important symptom for precaution and treatment of depression.
Acupunctural treatment for depression involved many aspects such as nervous endocrine, nervous transmitter and its receptor,immunity function,nervous transmitting signals channel. Part of the research involved a different transmitter,and the balancing relation between different parts of the brain,some of the researches might even be keen to know that acupuncture treatment help protect the withering of the sea horse neuron.The research showed that the functional mechanism of depression treated by acupuncture involved multi mechanism and its processes. Furthermore,there are researches that initiate an interest in mechanisms such as the relation among the transmitters of the central nervous,the comparison of the regional tissue and its functions of the brain,comparing the same nervous transmitter located at the central nerve and the relation among the peripheral nerve.
The research involved the selection of 5-HT SSRIs as an antidepressant to treat the depression patients cum sleeping disorder,that will help TCM upgrade the effective results in treating depression,seeking a wider clinical space for treatment,alleviate clinical effective results,reduce side effects of the medicine,so as to provide better ways for the treatment of depression.At present,SSRIs likes remains certain shortcomings of unconquerable difficulties, for example,the delay of effects,lots of side effects,the effects to both body and mental are limited,it takes 3 to 6 weeks to show the results,and the effective results is about 70%only.Due to all these problems,seeking non medicine treatment may lead to wider scope and of social significance.
In summary,the combination of acupuncture and antidepressant treatment is of much significance to the development of acupunctural treatment.It combines the advantages of medicine and acupuncture,thus exploring a wider and new sphere in treating sickness with acupuncture.Clinically,combining acupuncture with antidepressant in treating depression sickness is more commonly adopted,as the benefits are also more apparent.Acupuncture can be applied in treating and precaution of the depression cum sleeping disorders patients in a long term basis,it will help improve sleep,prevent recurrences,and is a positive way for treatments of the sickness.
[OBJECTIVES]
(1) Theoretical Research
1.To confirm that depression is a western medical term.Although various symptoms of depression also manifested in several sickness by definition of TCM.So far,there is no sickness defined by TCM that equalizes the Western term of depression.
2.To define sleeping disorder as sleeping at inappropriate times,addiction to sleep or insomnia.
3.To explore the reasons that lead to depression and sleeping disorder in Western medical mechanism.
4.To justify with statistics that Western treatment of depression produces slow and inconsistent results and are often accompanied by side effects.
5.To compare the distinct characteristics between the holistic effects of acupuncture and the single response of Western medicine.
6.To explore the guidance theory of "Brain is the house of vital spirit" as an advantage to treat depression cum sleeping disorders by acupuncture.
7.To prove that selected acu-points along Du Channel produce results as effective as tricyclic antidepressant;the improvement of anxiety and physical symptoms are also much better by using the acupuncture treatment.
(2) Clinical Research
This research explores the difference in mechanisms and curative effects of taking Selective Seretonine Reuptake Inhibitors(SSRIs) alone and combining with acupuncture-moxibustion in the treatment of depression cum sleeping disorders simultaneously.The control group underwent treatment by taking SSRIs alone while the experimental group underwent treatment that encompassed acupuncture-moxibustion and SSRIs.This study explores clinical effects of depression cum sleeping disorders as the mechanisms are examined to further develop the acupuncture treatment,raise clinical curative effects, alleviate side effects due to consumption of medicine and raise the quality of life for the patients.
[METHODS]
(1) Theoretical Research
1.To collect and assemble the documented data of treating depression cum sleeping disorder by TCM,
by analyzing and summarizing the contents of the data.
2.To collect and assemble the documented data of treating depression cum sleeping disorder by Western medicine,by analyzing and summarizing the contents of the data.
3.To collect and assemble the documented data of treating depression cum sleeping disorder by TCM and Western medicine,by analyzing and summarizing the contents of the data.
4.To summarize the above mentioned data,emphasizing the importance of combining acupuncture with medicine in treating depression cum sleeping disorders.
(2) Clinical Research
The observation was based on 60 cases of depression patients(all diagnosed by psychiatrists) extracted from KONG's TCM Singapore and Yu Guo Chinese Clinic Singapore during the period from September 2006 to December 2008.They were randomly assigned to two groups,the drug only group under control group and acupuncture-drug combination group under treated group,30 cases each,with comparability of sickness and age.Both used SSRIs for treatment of depression-the treated group with additional acupuncture treatment at Yintang,Shenting,Dazhui,Fengchi,Shenmen,Sanyinjiao,and moxibustion of the Baihui, combined with other acupoints according to differentiation and related symptoms,and control group by drug only,without acupuncture-moxibustion.To visit the patients of both groups once every 2 weeks,6 weeks constitute a treatment cycle.Prior to treatment as well as at the end of 2nd and 10~(th) week on treatment,the Hamilton Depression Rating Scale(HAMD), Pittsburgh Sleep Quality Index(PSQI),SDS,Asberg Side Effects Rating Scale(SERS) and Clinical General Impression Scale(CGI) are used to measure the curative effects of both of the groups through the changing rating scales of the instruments.
[RESULTS]
(1) Theoretical Research
1.By using the acu-points of Du channel,there is an apparent increase in the activities of 5-HT energy neuron within rapheal nuclei,at the same time it will increase the quantity volume contained in the substantia nigra and hypothalamus etc.It also will improve the blood circulation of the brain,upgrading the ability of antioxidants and improve the memory function.
2.Moxibustion of Baihui helps to regulate Ying and Yang,activate the brain and to tranquilize the heart.Moxibusting this acu-point helps to improve the blood circulation in the brain tissue and elasticity of the veins.Through the reflex of cerebral cortex,it helps to regulate the autonomic nervous systems.
It also treats the sickness of nervous systems.Moxibusting Baihui will help to control the brain from excessive excitement,to recover balance and coordination the brain functions from disorganization.
(2)Clinical Research
Using the HAMD rating scale,the acupuncture-drug group rated P＜0.01 in terms of before-after treatment conditions,whereas the drug-only group displayed only P＜0.05.This shows that although both treatment methods are effective,the acupuncture-drug group's condition improved much more significantly.During the second week of treatment,there was a difference of P＜0.05 in the two groups' conditions.During the tenth week of treatment,it appeared that there was no difference of improvement(P＞0.05) for both groups.Through the rating scale of HAMD,the effects of treatment showed no difference for both groups,though acupuncture combined group had earlier effects than that of the drug only group.
Using the Pittsburgh Sleep Quality Index(PSQI),the acupuncture-drug group rated P＜0.01 in terms of before-after treatment conditions,whereas the drug-only group showed no difference with a rating of P＞0.05.Thus,it demonstrates that the acupuncture treatment is effective to the rating scale of PSQI for the depression patients with significant statistics purposes.During the second week of treatment,there was a difference of P＜0.05 in the two groups' conditions.This demonstrates that the acupuncture-drug group acquired results much faster than the drug-only group.
Using the SDS scale,both groups displayed no difference(P＞0.05) in terms of beforeafter treatment,although there was a difference of P＜0.05 in the two groups' conditions during the second week.However,there was no difference(P＞0.05) in the two groups' conditions during the tenth week.
Through the rating scale of SDS,the effects of treatments showed no difference for both groups,though acupuncture combined group had earlier effects than that of the drug only group.
Using the Asberg Side Effects Rating Scale(SERS),both groups demonstrated no difference(P＞0.05) before and after treatments,thus it demonstrated that both of the groups do not have any significant improvement purposes to the rating scale of SERS.During the second week,as well as the tenth week of treatment,there was a significant difference of P＜0.01 between the two groups' conditions.
On the SERS scale,these statistics demonstrated that the acupuncture-drug group acquired faster and better effects than the drug-only group.
The severity of illness(SI) for both groups has no difference(P＞0.05).After ten weeks of treatment,the acupuncture-drug group showed better results than drug only group in regard to curative effects general index(GI),which has significant statistics purposes(P＜0.05);there is no difference in the Effects Index(P＞0.05).It demonstrated that combining acupuncture with drug has an affirmative curative effect on insomnia-depression.
[CONCLUSIONS]
(1)Theoretical Research
1.The advantages of curative effectiveness of acupuncture-antidepressant mainly showed in improving anxiety,sleeping disorder and physical symptoms.
2.Acupuncture combining antidepressant compensate for the shortcomings of slow results of taking antidepressant alone and to reduce side effects from Western medicine;It is also clinically proven that the effective results are fast and the curative effective high.
3.The foundation functions of acupuncture is to stimulate the patient's own endogenous regulatory mechanism,without the help from medicine,hence the absence of side effects.
4.Documented data showed that the depression treated by acupuncture acquired 76.67%, The rate of effectiveness by acupuncture-drug combination was also apparently higher.
5.Acupuncture can raise the function of monoaminenergic nervous system in the brain,increase the quantity volume contained in 5-HT,NE,DA of specific location of the brain,so as to improve the effective results of clinical symptoms of the depression patients.
(2)Clinical Research
1.Acupuncture-SSRIs combination for treatment of depression has an affirmative Curative effect;
2.Acupuncture-drug combination for the treatment of depression could effectively raise clinical curative effects,reflected by the quick results,especially towards improving sleeping disorder and anxiety insomnia:,whereas the control group did not produce the same results at the same rate.
3.Acupuncture-drug combination for the treatment of depression can reduce symptoms of sideeffects.
有61.8%的抑郁症患者首发症状为睡眠障碍,而没有睡眠障碍的抑郁症患者大约只占1%,睡眠障碍存在中至重度抑郁者分别为31%。睡眠障碍也可以加重抑郁症的病情,延缓抑郁症的康复进程,因此睡眠障碍的改善对抑郁症的缓解与康复必然有促进作用;睡眠障碍可作为抑郁症新的发作和再发的预测和防治指标,是预测和防治抑郁症的关键症状。
针灸治疗抑郁症研究已涉及神经内分泌、神经递质及其受体、免疫功能、神经信号传导通路等方面,此外,部分研究还涉及不同递质、脑内不同区域之间的平衡关系,有研究还关注了针灸对海马神经元细胞凋亡和保护的影响,研究发现,针灸治疗抑郁症的作用机制也与多个机制和过程有关。另外,已经有研究开始关注多个机制之间的关系,如中枢神经递质之间的关系,大脑不同区域组织和功能的比较,同一神经递质在中枢和外周之间的关系等。
本研究针灸介入选择性5-羟色胺再摄取抑制剂(SSRIs类抗抑郁药)治疗抑郁症伴睡眠障碍,可提高中医在治疗抑郁症中的作用与地位,拓宽临床治疗思路,为提高临床疗效、减少药物的副作用提供更为确切的方法。目前SSRIs类药物仍然存在一些无法克服的不足,例如起效延迟、副反应多,以及对躯体症状和心理症状作用有限,并需要3～6wk才能发挥其疗效,有效率仅在70%左右等问题。因此,寻求非药物疗法治疗本病具有广泛的应用前景及社会意义。
综上所述,针灸结合抗抑郁药是针灸发展的重要途径,它结合了针灸与药物的双重优势,拓宽了针灸治疗的病种,使针灸涉足到更多更新的领城。针灸结合抗抑郁药的方法在临床上愈来愈广泛地被应用,并显示出明显的优势。针灸可作为抑郁症伴睡眠障碍长期防治方法,对改善睡眠障碍、防治抑郁复发起着积极医疗效应。
目的:
(1)理论研究:
1.明确抑郁症是西医病名,虽然抑郁症的表现形式可在多种中医病名的症状群中出现,就目前来讲还不能将抑郁症直接等同于某一中医病名。
2.明确睡眠障碍泛指睡眠紊乱,包括中医的失眠及嗜睡。
3.探讨抑郁症、睡眠障碍西医发病机制。
4.许多文献研究显示西药治疗存在起效慢、副作用大、患者依从性差等不足。
5.分析针灸调整作用的整体性与西药作用比较单一的特点有显著差别。
6.探讨“脑为元神之府”理论指导抑郁伴睡眠障碍的针灸治疗优势。
7.明确针灸督脉为主经穴治疗这类病症的疗效与三环类药物相当,同时对诸如焦虑/躯体化等症状改善优于后者。
(2)临床研究:
观察抑郁症伴睡眠障碍的病患服食选择性5-羟色胺再摄取抑制剂(SSRIs类抗抑郁药)的同时,进行针刺督脉为主穴位加灸百会穴的针灸治疗组(治疗组),与单纯服用选择性5-羟色胺再摄取抑制剂(SSRIs类抗抑郁药),不进行针灸(对照组)的临床疗效,寻找治疗抑郁症睡眠障碍的有效方法;探讨针刺督脉为主穴位加灸百会穴在治疗抑郁症伴睡眠障碍患者的作用机理、以期开拓针灸防治疾病的多向性。为提高临床疗效、减少药物的副作用、提高患者生活质量提供确切方法。
方法:
(1)理论研究:
1.收集中医治疗抑郁、睡眠障碍文献进行分析、综述。
2.收集西医治疗抑郁、睡眠障碍文献进行分析、综述。
3.收集中西医结合治疗抑郁、睡眠障碍文献进行分析、综述。
4.综合上述资料说明针灸结合药物治疗治疗抑郁症伴睡眠障碍的重要性。
(2)临床研究
2006年9月～2008年12月选取60例新加坡KONG'S TCM＆新加坡育国中医诊疗所私人有限公司门诊病人(均由精神科医生诊断为抑郁症),随机分为2组,治疗组与对照组各30例。2组的病情、年龄等基本情况具有可比性。2组同样常规服食选择性5-羟色胺再摄取抑制剂(SSRIs类抗抑郁药)治疗组服食SSRIs类抗抑郁药同时针刺印堂、神庭、大椎、风池(双)、神门(双)、三阴交(双),灸百会,配合辨证取穴和随证加减,每周治疗二次,治疗2周作一次随访,治疗10周为一疗程。对照组只服食SSRIs类抗抑郁药不进行针灸,2周作一次随访,观察时间为10周。于治疗前、治疗第2周、第10周末观察治疗组与对照组之间的汉密尔顿(HAMD)量表、匹兹堡睡眠质量指数评定量表(PSQI)、自评抑郁量表(SDS)、Asberg副作用量表(SERS)、临床疗效总评量表(CGI)的变化。
结果:
(1)理论研究:
1.针灸督脉经穴可使中缝核内5-HT能神经元活动明显增加,黑质、下丘脑等处5-HT含量增加。并且可以改善脑部血液循环,提高脑组织抗氧化能力,改善记忆功能。
2.灸百会有调整阴阳、醒脑开窍、宁心安神之功。艾灸此穴能改善脑组织血液供应及血管弹性,并能通过大脑皮层的反射调节自主神经,进而对神经系统疾病起到治疗作用;艾灸百会穴能抑制脑的异常兴奋,使紊乱的脑功能恢复平衡、协调。
(2)临床研究:
经过10周治疗后,治疗组的汉密尔顿(HAMD)量表、自身前后对比有非常显着差异(P＜0.01);对照组自身前后对比有差异(P＜0.05),说明两种治疗方法对改善抑郁症患者汉密尔顿(HAMD)量表评分均有效,具有统计学意义。在治疗过程中(第2周),两种治疗方法相比对于改善汉密尔顿(HAMD)量表评分有差异(P＜0.05):在治疗结束时(第10周),两种治疗方法相比对于改善汉密尔顿(HAMD)量表评分则无差异(P＞0.05),提示此两种治疗方法相比虽然最终对于改善汉密尔顿(HAMD)量表评分无差异,但针灸治疗组的效果要快于药物组。
经过10周的治疗,针灸治疗组自身前后对比匹兹堡睡眠质量指数评定量表(PSQI)评分有非常显着差异(P＜0.01);药物对照组自身前后对比无差异(P＞0.05),说明针灸对改善抑郁症患者匹兹堡睡眠质量指数评定量表(PSQI)评分有效,具有统计学意义。在治疗过程中(第2周),两种治疗方法相比对于改善匹兹堡睡眠质量指数评定量表(PSQI)评分有差异(P＜0.05),提示针灸治疗组的效果要优于药物组。
经过10周的治疗,两组自身前后对比自评抑郁量表(SDS)评分均无差异(P＞0.05);说明这两种方法对抑郁症患者自评抑郁量表(SDS)评分的改善均无统计学意义。在治疗过程中(第2周),两种治疗方法相比对于改善自评抑郁量表(SDS)评分有差异(P＜0.05);在治疗结束时(第10周),两种治疗方法相比对于改善自评抑郁量表(SDS)评分则无差异(P＞0.05),提示此两种治疗方法相比虽然最终对于改善自评抑郁量表(SDS)评分无差别,但治疗组的效果要快于对照组。
经过10周的治疗,两组自身前后对比Asberg副作用量表(SERS)评分均无差异(P＞0.05);说明这两种方法对抑郁症患者Asberg副作用量表(SERS)评分的改善均无统计学意义。在治疗过程中(第2周),两种治疗方法相比对于改善Asberg副作用量表(SERS)评分有非常显着差异(P＜0.01);在治疗结束时(第10周),两种治疗方法相比对于改善Asberg副作用量表(SERS)评分亦有非常显着差异(P＜0.01),提示治疗组对于改善抑郁症Asberg副作用要优于对照组。
两组在病情严重程度(SI)上无差异(P＞0.05);经过10周的治疗,在疗效总评(GI)上治疗组优于对照组,有统计学意义(P＜0.05):在疗效指数(EI)上两组相比无差别(P＞0.05)。提示针灸结合SSRIs类药物对于抑郁症伴睡眠困难具有确切的疗效。
结论:
(1)理论研究:
1.针灸结合抗抑郁药的疗效优势主要体现在可以更好改善焦虑、睡眠障碍等躯体症状。
2.针灸结合抗抑郁药可以弥补抗抑郁药起效较慢问题,可以减轻西药副反应;临床已显示出起效快、疗效高的互补优势。
3.针灸作用的基础在刺激患者自身内源性调节机制的发挥,无须借助于药物而起作用,因而对人体不会有任何副作用。
4.文献表明单独的针刺治疗治疗抑郁症的显愈率为76.67%,而针灸结合抗抑郁药则更能明显提高显效率和总有效率。
5.针灸可以提高脑内单胺能神经系统功能,增加脑中特定部位5-HT、NE、DA含量,以改善抑郁症患者临床症状。
(2)临床研究:
1.针灸结合SSRIs类药物对于抑郁症具有确切的疗效,针灸可作为SSRIs类药物治疗抑郁症伴睡眠障碍的辅助疗法。
2.针灸结合药物治疗抑郁症伴睡眠障碍可以有效提高临床疗效,其优势主要体现在见效快,对抑郁症伴发的躯体症状和睡眠障碍的改善明显优于单纯使用SSRIs类药物。
3.针灸结合药物治疗抑郁症伴睡眠障碍能够减轻因药物的副作用所引起的各种症状。
Depression is a common illness in the modern world.It has a high rate of repetition and suicides,the patients remain in a prolonged state of depressed situation with symptoms of low spirit,physical discomfort and sleeping disorder.Depression can be generalized in three aspects: low spirit,sharp drop in ability and some physical symptoms.
Among the depression patients,there are 61.8%who start with the symptoms of sleeping disorder,only 1%of depression patients do not display sleeping disorder.31%of the medium to severe depression patients experience sleeping disorder.Sleeping disorder may worsen the depression and delay the recovery process.Thus,improvement of sleeping disorder is an advantage factor for alleviation and recovery of the depression patients.Sleeping disorder is a predictive factor of any depression relapse,it is also an important symptom for precaution and treatment of depression.
Acupunctural treatment for depression involved many aspects such as nervous endocrine, nervous transmitter and its receptor,immunity function,nervous transmitting signals channel. Part of the research involved a different transmitter,and the balancing relation between different parts of the brain,some of the researches might even be keen to know that acupuncture treatment help protect the withering of the sea horse neuron.The research showed that the functional mechanism of depression treated by acupuncture involved multi mechanism and its processes. Furthermore,there are researches that initiate an interest in mechanisms such as the relation among the transmitters of the central nervous,the comparison of the regional tissue and its functions of the brain,comparing the same nervous transmitter located at the central nerve and the relation among the peripheral nerve.
The research involved the selection of 5-HT SSRIs as an antidepressant to treat the depression patients cum sleeping disorder,that will help TCM upgrade the effective results in treating depression,seeking a wider clinical space for treatment,alleviate clinical effective results,reduce side effects of the medicine,so as to provide better ways for the treatment of depression.At present,SSRIs likes remains certain shortcomings of unconquerable difficulties, for example,the delay of effects,lots of side effects,the effects to both body and mental are limited,it takes 3 to 6 weeks to show the results,and the effective results is about 70%only.Due to all these problems,seeking non medicine treatment may lead to wider scope and of social significance.
In summary,the combination of acupuncture and antidepressant treatment is of much significance to the development of acupunctural treatment.It combines the advantages of medicine and acupuncture,thus exploring a wider and new sphere in treating sickness with acupuncture.Clinically,combining acupuncture with antidepressant in treating depression sickness is more commonly adopted,as the benefits are also more apparent.Acupuncture can be applied in treating and precaution of the depression cum sleeping disorders patients in a long term basis,it will help improve sleep,prevent recurrences,and is a positive way for treatments of the sickness.
[OBJECTIVES]
(1) Theoretical Research
1.To confirm that depression is a western medical term.Although various symptoms of depression also manifested in several sickness by definition of TCM.So far,there is no sickness defined by TCM that equalizes the Western term of depression.
2.To define sleeping disorder as sleeping at inappropriate times,addiction to sleep or insomnia.
3.To explore the reasons that lead to depression and sleeping disorder in Western medical mechanism.
4.To justify with statistics that Western treatment of depression produces slow and inconsistent results and are often accompanied by side effects.
5.To compare the distinct characteristics between the holistic effects of acupuncture and the single response of Western medicine.
6.To explore the guidance theory of "Brain is the house of vital spirit" as an advantage to treat depression cum sleeping disorders by acupuncture.
7.To prove that selected acu-points along Du Channel produce results as effective as tricyclic antidepressant;the improvement of anxiety and physical symptoms are also much better by using the acupuncture treatment.
(2) Clinical Research
This research explores the difference in mechanisms and curative effects of taking Selective Seretonine Reuptake Inhibitors(SSRIs) alone and combining with acupuncture-moxibustion in the treatment of depression cum sleeping disorders simultaneously.The control group underwent treatment by taking SSRIs alone while the experimental group underwent treatment that encompassed acupuncture-moxibustion and SSRIs.This study explores clinical effects of depression cum sleeping disorders as the mechanisms are examined to further develop the acupuncture treatment,raise clinical curative effects, alleviate side effects due to consumption of medicine and raise the quality of life for the patients.
[METHODS]
(1) Theoretical Research
1.To collect and assemble the documented data of treating depression cum sleeping disorder by TCM,
by analyzing and summarizing the contents of the data.
2.To collect and assemble the documented data of treating depression cum sleeping disorder by Western medicine,by analyzing and summarizing the contents of the data.
3.To collect and assemble the documented data of treating depression cum sleeping disorder by TCM and Western medicine,by analyzing and summarizing the contents of the data.
4.To summarize the above mentioned data,emphasizing the importance of combining acupuncture with medicine in treating depression cum sleeping disorders.
(2) Clinical Research
The observation was based on 60 cases of depression patients(all diagnosed by psychiatrists) extracted from KONG's TCM Singapore and Yu Guo Chinese Clinic Singapore during the period from September 2006 to December 2008.They were randomly assigned to two groups,the drug only group under control group and acupuncture-drug combination group under treated group,30 cases each,with comparability of sickness and age.Both used SSRIs for treatment of depression-the treated group with additional acupuncture treatment at Yintang,Shenting,Dazhui,Fengchi,Shenmen,Sanyinjiao,and moxibustion of the Baihui, combined with other acupoints according to differentiation and related symptoms,and control group by drug only,without acupuncture-moxibustion.To visit the patients of both groups once every 2 weeks,6 weeks constitute a treatment cycle.Prior to treatment as well as at the end of 2nd and 10~(th) week on treatment,the Hamilton Depression Rating Scale(HAMD), Pittsburgh Sleep Quality Index(PSQI),SDS,Asberg Side Effects Rating Scale(SERS) and Clinical General Impression Scale(CGI) are used to measure the curative effects of both of the groups through the changing rating scales of the instruments.
[RESULTS]
(1) Theoretical Research
1.By using the acu-points of Du channel,there is an apparent increase in the activities of 5-HT energy neuron within rapheal nuclei,at the same time it will increase the quantity volume contained in the substantia nigra and hypothalamus etc.It also will improve the blood circulation of the brain,upgrading the ability of antioxidants and improve the memory function.
2.Moxibustion of Baihui helps to regulate Ying and Yang,activate the brain and to tranquilize the heart.Moxibusting this acu-point helps to improve the blood circulation in the brain tissue and elasticity of the veins.Through the reflex of cerebral cortex,it helps to regulate the autonomic nervous systems.
It also treats the sickness of nervous systems.Moxibusting Baihui will help to control the brain from excessive excitement,to recover balance and coordination the brain functions from disorganization.
(2)Clinical Research
Using the HAMD rating scale,the acupuncture-drug group rated P＜0.01 in terms of before-after treatment conditions,whereas the drug-only group displayed only P＜0.05.This shows that although both treatment methods are effective,the acupuncture-drug group's condition improved much more significantly.During the second week of treatment,there was a difference of P＜0.05 in the two groups' conditions.During the tenth week of treatment,it appeared that there was no difference of improvement(P＞0.05) for both groups.Through the rating scale of HAMD,the effects of treatment showed no difference for both groups,though acupuncture combined group had earlier effects than that of the drug only group.
Using the Pittsburgh Sleep Quality Index(PSQI),the acupuncture-drug group rated P＜0.01 in terms of before-after treatment conditions,whereas the drug-only group showed no difference with a rating of P＞0.05.Thus,it demonstrates that the acupuncture treatment is effective to the rating scale of PSQI for the depression patients with significant statistics purposes.During the second week of treatment,there was a difference of P＜0.05 in the two groups' conditions.This demonstrates that the acupuncture-drug group acquired results much faster than the drug-only group.
Using the SDS scale,both groups displayed no difference(P＞0.05) in terms of beforeafter treatment,although there was a difference of P＜0.05 in the two groups' conditions during the second week.However,there was no difference(P＞0.05) in the two groups' conditions during the tenth week.
Through the rating scale of SDS,the effects of treatments showed no difference for both groups,though acupuncture combined group had earlier effects than that of the drug only group.
Using the Asberg Side Effects Rating Scale(SERS),both groups demonstrated no difference(P＞0.05) before and after treatments,thus it demonstrated that both of the groups do not have any significant improvement purposes to the rating scale of SERS.During the second week,as well as the tenth week of treatment,there was a significant difference of P＜0.01 between the two groups' conditions.
On the SERS scale,these statistics demonstrated that the acupuncture-drug group acquired faster and better effects than the drug-only group.
The severity of illness(SI) for both groups has no difference(P＞0.05).After ten weeks of treatment,the acupuncture-drug group showed better results than drug only group in regard to curative effects general index(GI),which has significant statistics purposes(P＜0.05);there is no difference in the Effects Index(P＞0.05).It demonstrated that combining acupuncture with drug has an affirmative curative effect on insomnia-depression.
[CONCLUSIONS]
(1)Theoretical Research
1.The advantages of curative effectiveness of acupuncture-antidepressant mainly showed in improving anxiety,sleeping disorder and physical symptoms.
2.Acupuncture combining antidepressant compensate for the shortcomings of slow results of taking antidepressant alone and to reduce side effects from Western medicine;It is also clinically proven that the effective results are fast and the curative effective high.
3.The foundation functions of acupuncture is to stimulate the patient's own endogenous regulatory mechanism,without the help from medicine,hence the absence of side effects.
4.Documented data showed that the depression treated by acupuncture acquired 76.67%, The rate of effectiveness by acupuncture-drug combination was also apparently higher.
5.Acupuncture can raise the function of monoaminenergic nervous system in the brain,increase the quantity volume contained in 5-HT,NE,DA of specific location of the brain,so as to improve the effective results of clinical symptoms of the depression patients.
(2)Clinical Research
1.Acupuncture-SSRIs combination for treatment of depression has an affirmative Curative effect;
2.Acupuncture-drug combination for the treatment of depression could effectively raise clinical curative effects,reflected by the quick results,especially towards improving sleeping disorder and anxiety insomnia:,whereas the control group did not produce the same results at the same rate.
3.Acupuncture-drug combination for the treatment of depression can reduce symptoms of sideeffects.
引文
[1]杨志新.抑郁症.《中国临床医生》,2006;34(9):18-20
[2]杨坤.指导:谢光荣教授.S100B基因多态性与抑郁症发病的关联及抑郁症睡眠脑电生理特征的探讨(博士学位论文).中南大学,2007年5月
[3]舒良.抑郁症的评定与治疗.中华医学杂志,1999;79(5):398-400
[4]牟君.指导教师姓名:谢鹏教授.抑郁症的脑功能磁共振和蛋白组学研究(重庆医科大学博士学位论文),2007年6月
[5]新加坡联合早报.2007年09月10日:7
[6]亢明.34例抑郁症患者睡眠障碍临床分析.临床精神医学杂志,1998;8(4):213-214
[7]王祖承.难治性精神疾病.上海科学技术出版社,2007:157-158
[8]施建安,王版,焕林.失眠症的研究进展.中华神经精神科杂志,1994;22(5):287
[9]李晓白,黄继忠,王祖承.抑郁症与谷氨酸传导.中国新药与临床杂志,2005:24(8):601-604
[10]罗和春,沈渔邨,贾云奎,等.电针治疗133例抑郁症患者临床疗效观察[J].中西医结合杂志,1988;8(2):77
[11]刘兰英 王玲玲.“脑为元神之府”理论在针灸治疗抑郁症中的指导意义.针灸临床杂志,2003;19(8):6-8
[1]中国中西医结合研究会精神病专业委员会.躁郁证的中西医结合辨证分型标准[J].中西医结合杂志,1998;8(2):127-128
[2]姜劲峰,王玲玲,王俊,等.抑郁症从升降理论辨证的探讨.中国中医基础医学杂志,2006:第12(8):598-599
[3]卫永琪.中医辨证治疗老年抑郁症[J].四川中医,2004;22(12):44-45
[4]吕红艳.辨证论治抑郁症疗效观察[J].广西中药,2002;25(2):14-16
[5]苏根.辨证施治老年抑郁症30例[J].中医研究,2004;17(1):45-46
[6]张金茹.小柴胡汤治疗抑郁症40例[J].北京中医,2003,22(5):38-39
[7]唐启盛,侯德明,陈密文,等.颐脑解郁法治疗轻、中度抑郁症的开放性临床研究[J].中国临床康复,2002:6(21):3207
[8]杨进,谢忠礼,沈炳章,等.菖欢胶囊治疗抑郁性神经症临床观察[J].南京中医药大学学报(自然科学版),2003,19(2):78-80
[9]金杰,陈海燕,赵铎,等.加味百合地黄汤治疗抑郁性神经症35例[J].山西中医,2001:17(2):21
[10]刘黎明.补达饮治疗抑郁症40例[J].陕话中医,2004;25(10):876-877
[11]王天俊.针刺治疗抑郁症临床观察[J].中国针灸,2005;25(2):107-108
[12]尹秀茹.电针治疗抑郁症30例临床观察[J].河北中医,2005;27(7):527-528
[13]江小荣.芒针治疗抑郁症47例临床观察[J].中医药学刊,2003;21(9):1567-1568
[14]张丹莉.针刺在抑郁症患者中的应用[J].中匡临床康复,2005:9(20):217
[15]唐胜修,徐祖豪,唐萍,等.针刺治疗抑郁性神经症的临床研究[J].中国针灸,2003;23(10):585-586
[16]吕梅,王玲玲.针刺治疗抑郁症选穴频次的分析.针灸临床杂志,2003;19(8):15
[17]罗和春.新电针疗法治疗抑郁症研究进展的启示.中国中话医结合杂志,2000;20(11):806-807
[18]韩毳,罗和春,李晓泓,等.电针与麦普替林治疗抑郁症患者的对照研究.中国中西医结合杂志,2002:22(7):512-514.
[19]任建宁.耳针治疗抑郁症50例.河南中医,2005;25(2):75.
[20]李德平,王宝玲.腹针治疗抑郁症44例.上海针灸,2005:24(3):22.
[21]黄泳,夏东斌.头电针治疗抑郁症30例临床观察.中西医结合学报,2004;,2(2):151-160.
[22]黄庆元,李建国.中国道家认知疗法治疗抑郁症35例临床观察.甘肃中医,2005:9(18):18-19.
[23]张国泰.浅谈张子和的情志疗法.光明中医,2000;15(6):38-39
[24]胡永年.略谈以情胜情疗法.湖北中医杂志,2000;22(7):9-10
[25]周庆.中医治疗抑郁症.医学综述,2003:9(5):316-317
[26]武丽,张丽萍,叶庆莲,等.加减温胆汤对抑郁模型大鼠行为学和血浆生长抑素含量的影响.中国临床康复,2005:9(8):114-116.
[27]薛征.脾肾两助丸抗抑郁作用的实验研究.山西中医学院学报,2003:4(4):14-16
[28]冯文林.抑郁症的中医药实验研究概况.浙江中医杂志,2002:11:502-503
[29]傅强,马世平.半夏厚朴汤抗抑郁作用的研究.中国药科大学学报,2002:33(6):514-517
[30]何咏梅,杜绍礼.抗抑郁中药的研究进展.湖南中医药导报,2003:9(6):71-73
[31]陈瑶,秦路平.积雪草总苷对抑郁症大鼠神经内分泌功能的影响.第二军医大学学报,2002;23(11):1224-1226
[32]司银楚,孙建宁.贯叶连翘提取物对慢性应激抑郁大鼠行为及脑内5-HT,NE表达的影响.中国医科大学学报,2003;34(1):70-73
[33]李作平,赵丁,任雷鸣,等.合欢花抗抑郁作用的药理实验研究初探.河北医科大学学报,2003;24(4):214-216
[34]冯文林.抑郁症的中医药实验研究概况.浙江中医杂志,2002:11:502-503
[35]俞瑾,李晓艳,曹小定,等.电针合用抗抑郁药能明显减少小鼠强迫游泳实验中的静止时间.针刺研究,2002:27(2):119-123.
[36]李文迅,韩焱晶,隋娟,等.电针对抑郁模型大鼠海马神经元凋亡的影响.中国中医药信息杂志,2005:12(2):33-35.
[37]徐云生.邓铁涛教授治疗失眠的经验.新中医,2000;32(6):5
[38]邓红,王多让.从气血论治失眠症经验.实用中医药杂志,2000;16(5):37
[39]吕春芳,解静.吕同杰治疗顽固性失眠经验.山东中医杂志,2000;19(5):301
[40]毛海燕,张珍玉.辨治失眠经验.山东中医杂志,2002:21(6):369
[41]周恩庆.安魂定志汤治疗失眠证例临床观察.中国中医基础医学杂志,2002;8(1):31
[42]张根明,宋琪,张章.抑郁障碍相关性失眠的临床特点及中医证候分布情况初步研究.北京中医药大学学报(中医临床版),2008:15(1)Pg12-14
[43]中华医学会精神科分会.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,2001:87-88
[44]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:19-20
[45]贺建华,张茁.失眠的诊断[J].中国全科医学,2006:9(8):619-620
[46]失眠定义、诊断及药物治疗共识专家组.失眠定义、诊断及药物治疗专家共识(草案)[J].中华神经科杂志,2006:39(2):141-143
[47]汪向东,王希林,马弘,等.心理卫生评定量表手册(增订版)rM].北京:中国心理卫生杂志社,1999:375-378
[1]房玉新编辑.打破高患病率与低识别率之间矛盾的坚冰--就抑郁症与周东丰教授一席谈.中华医学杂志,1999;79(5):398-400
[2]张宝华.抑郁症认知功能障碍的研究进展中国慢性病预防与控制.2006:(8):298-300
[3]袁浩龙.抑郁症病因的神经内分泌学研究进展.临床精神医学杂志,1995;5(6):365-367
[4]沈渔邨.精神病学[M].第3版.北京:人民卫生出版社,1994:631。
[5]王祖新.抑郁症的病因学研究中华内科杂志.1998;37(8):568
[6]Schildkraut JJ.The catecholamine hypothesis of affective disorders:a review of supporting evidence.Am J Psychiatry.1965:122:509-512,
[7]MarazzitiD,Baronis:MasalaI,etal.correlationbetweenplateletalpha(2)Adrenoreceptors and symptom severity in major De-pression[J].Neuropsychobiology,2001:44:122-125.
[8]Coppen A.,Shaw DM.,Mallerson A.Changes in 5-hydroxy-tryptophan metabolism in depression.Brit S Psychiat 1965:111
[9]Pandey GN.Altered serotonin function in suicide:Evldence from platelet and neuroendocine studies.Ann N Y Acad Sci,1997:836:182,
[10]吕路线,宋景贵,卢红,等.卒中后抑郁状态患者的血浆,脑脊液单胺神经递质测定.[J]中华精神科杂志;2000,33(1):29-32.
[11]Yatham LN,liddle PF,shiah Is,et al.Brain serotoninz receptorsin major depression:a positron emission tomography study[J].Arch gen Psychiatry,2000:57:850-8.
[12]Mann JJ,HuangYY,underwood MD,et al.Aserotonin trans-porter gene promoter polymorphism(5-HTTLPR)and prefron-talcortical binding in major depression and suicide[J].ArchGen Psychiatry,2000;57:729-738.
[13]潘桂花,林治光,徐韬园,等.抑郁症患者血小板五羟色胺浓度的研究.上海精神医学,2005;17(3):145-147。
[14]王祖新.抑郁症的病因学研究.中华内科杂志,1998;37(8):568
[15]潘玉芹,林文娟.海马52羟色胺系统与抑郁症.中国行为医学科学.2006;15,4:379-380
[16]Willner P.Dopamine and depression:A review of recent evidence.Brain Res.Rev.1983;6:211-246
[17]Bowden C,Theodorou AE,Cheetham SC,et al、 Dopamine D1 and D2 receptor binding sites in brain samples from depressed suicides and controis.Brain Res.1997:752:227-233.
[18]Steffens DC,Byrum CE,McQuoid DR et al.Hippocampal volume in geriatric depression.Biol Psychiat,2000;48:301-309,
[19]Krystal JH,Petraki s IL,D' Souza DC,et al.Interactive effects of high dose intravenous glycine and oral D-cycloserine in healthy human subjects.Biol Psychiat,1997;41(Suppl):
[20]MAURIMC,etal.Neuropsychobiology,1998;37:124-129,
[21]Sanacora G,Mason GF,Rothman DL,et al,Reduced cortical GABA levels in depressed patients determined by 1 H-magnetic resonance spectroscopy[J].Arch Gen Psychiat,1999;56:1043-1047,
[22]张黎明,李云峰,宫泽辉.神经元再生:抑郁症治疗的新策略[J].生理科学进展,2005:36(2):109=112。
[23]李晓照,陈泽奇,胡随瑜,等.抑郁症患者血清BDNF水平与相关因素分析.中匡临床心理学杂志,2005;13(3):312-313
[24]mitchell AJ.The role of corticotropin releasing factor in depres-sive illness:a criticalreview[J].neurosciBiobehavRev,1998,22(5):635-741.
[25];steogersteogerA,holsboer F.nocturnal secretion of prolactin and corti-sol and the sleep BCG in patients with mjor endogenous depres-sion during an acute episode and after full remission[J].Psychia-try Res,1997,72(2):81-87.
[26]刘健.抑郁症和阿尔采木氏病的HPA轴功能[J].国外医学#精神病学分册,1997:24(2):119-120。
[27]崔青,侯钢,孙静,等.抑郁症晨重夕轻特征与生物学的关系.临床精神医学杂志,2006;16(5):266-268
[28]WATSON SJ.Biology of schizophrenia and affective disease[J].London:American Psychiatric press,1996:259.
[29]许绍芬.神经生物学[M].上海医科大学出版社:1990:228.
[30]Rubinow DR,schmidt PJ,Roca CA.Estrogen-serotonin inter- actions:Implications for affective regulation[J].Biol psychia- try,1998:44(5):799-811.
[31]李强,尚翠侠,马现仓,等.抑郁症患者的性激素分析[J].中匿神经精神疾病杂志,1999:25(5):271-273.
[32]Horsten M,WamalaSP,VingerhoetsA,et al.Depressive symp toms and support and lipid Profile in healthy niddle aged women[J].PsychosomMed,1997:59(5):521
[33]赵汉清,崔庶,端义扬,等.低血清胆匿醇与女性抑郁症的自杀行为[J].中国神经精神疾病杂志,2000;26(2):78-80.
[34]何舒,林渝峰,李霞.抑郁症的发病机制研究进展.四川生理科学杂志,2006;28(3):123-128
[35]郭新胜,许明智,师天元.内源性抑郁症患者存在脂质代谢异常.第三属全国临床检验实验室管理学术会议:229-230
[36]何舒,林渝峰,李霞.抑郁症的发病机制研究进展.四川生理科学杂志,2006:28(3):123-128
[37]骆晓林,陈昌惠,李淑然,等.45岁以上抑郁病人与正常人理!免疫功能的比较研究[J].中国临床心理杂志,1997;5(2):83-86
[38]王长虹,周东丰,管振权.抑郁症患者治疗前后认知、内分泌、细胞因子的变化.中国心理卫生杂志,2006;20(7):434-436
[39]苏晖,江开达.抑郁症的认知功能障碍.上海精神医学,2006;18(4):244-245
[40]武力勇,魏镜,李舜伟.抑郁症患者伴发认知功能损害的研究进展.中华精神科杂志,2004;37(3):188-189
[41]张宝华.抑郁症认知功能障碍的研究进展.中国慢性病预防与控制.2006;(8):298-300
[42]苏晖,江开达.抑郁症的认知功能障碍.上海精神医学2006;18(4):244-245
[43]喻东山.抑郁症的神经解剖基础.国外医学精神病学分册,1995;22(2):107-109
[44]Krishnan KR,Hays JC,Blazer DG.MRI-defined vascular depression.Am J Psychiat.1997;154:497-541.
[45]Macfall JR,Payne ME,Provenzale JE,et al.Medial orbital frontal lesions in lateonset depression.Biol Psychiat.2001;49:803-806.
[46]brevets WC,Price JL,Simpson JR Jr,et al.Subgenual prefrontal cortex abnormalities in mood disorders.Nature.1997;386:824-827.
[47]Drevets WC.Functional anatomical abnormalities in limbic and prefrontal cortical structures in major depression.Prog BrainRes.2000;126:413-431.
[48]Rajkowska G,Miguel-Hidalgo JJ,Wei J,et al.Morphometric evidence for neuronal and glial prefrontal cell pathology in major depression.Biol Psychiat.1999:45:1085-1098.
[49]Kumar A,Thorns A,Laxetsky H,et al.Frontal white matter biochemical abnormalities in late-life major depression detected with proton magnetic resonance spectroscopy.Am J Psychiatry.2002;159:630-639
[50]Coffey CE,Figiei GS,Djang WT,Saunders WB,Weiner RD.White matter hyperintensity on magnetic resonance imaging:clinical and neuroanatomic correlates in the depressed elderly.J.Neuropsychiat.Clin.Neurosci.1989:1:135-144.,
[51]Krishnan KR,Hays JC,Blazer DG MRI-defined vascular depression.Am.J.Psychiat.1997;154:497-501.
[52]MacFall JR,Payne ME,Provenzale JE,Krishnan KR.Medlal orbital frontallesions in lateonset depression.Biol.Psychiat.2001:49:803-806.
[53]林文娟.精神与免疫.见:21世纪初科学发展趋势课题组编《.21世纪100个科学难题》.吉林出版社,1998;693-701
[54]宏宇,林文娟.白细胞介素-1在病态行为中的作用及其机理.心理科学进展,2004;12(2):290-295
[55]何舒,林渝峰,李霞.抑郁症的发病机制研究进展.四川生理科学杂志,2006;28(3)Pg123-128
[56]陈斌贝,周斌,詹秀琴.药物免疫促进剂与抑郁症相关性探讨.浙江中西医结合杂志,2006;16(7):455-456
[57]汪春运.抑郁症的躯体症状.《临床荟萃》,2006;5,21(9):670-671
[58]王祖新.抑郁症的病因学研究.中华内科杂志,1998;8,137(8):568
[59]诊断及药物治疗共识专家组.失眠定义,诊断及药物治疗专家共识(草案)[J].中华神经科杂志,2006;39(2):141-143
[60]慈书平,张希龙,杨宇,等.睡眠与睡眠疾病.军事医学科学出版社130-133
[61]陈圣祺,李广智.《名医会诊·失眠症》上海文化出版社:5
[62]翁思琪.神经生物学原理.北京医科大学出版社,1999:4
[63]贾永蕊,胡然,库宝善.几种常见精神疾患的睡眠障碍.国外医学精神病学分册,2003 30(2):111-113
[64]陈圣祺,李广智.《名医会诊·失眠症》.上海文化出版社,6-7
[65]龚绍麟.抑郁症.人民卫生出版社,267-270。
[66]杨本付,张作记,岳喜同.医学生睡眠质量与焦虑抑郁情绪关系的探讨.中国行为医学科学1999;9(5):346-347.
[67]Ford DE.Frame row DB Epidemiological study of sleep disturbance and psychiatric disorders.JAMA 1989:262:1479
[68]Chang PP,Ford DE,Mead LA,et al.Insomnia in young men and subsequent depression:the Johns Hopkins Precursors Study.Am J Epidemiol,1997:146:105-114
[69]张希龙,杨宇,潘集阳,等.睡眠与睡眠疾病.军事医学科学出版社,129。
[70]王健.睡眠医学的研究.中国临床康复,2004;8(3):544-546
[71]余海鹰.抑郁症睡眠障碍研究新进展.国外医学·精神病学分册,1999;26(3),138-140
[72]唐启盛.郁症中西医基础与临床.中国中医药出版社,138
[73]BenaRMBenaRM,ObermeyerWH,Thistec,eta.lSleepandpsychiat-ricdisorder:ameta-analysis.ArchGenPsychiatry,1992,49:651-668
[74]余海鹰,崔庶,王宏,等.抑郁症患者睡眠行为及睡眠生理障碍的研究(J1.中华精神科杂志,2000:33(1):23-5
[75]沈渔邨.神经生理学原理.北京:医科大学出版社,1999;1132-1142.
[76]亢明.34例抑郁症患者睡眠障碍临床分析.临床精神医学杂志,1998;8(4):213-214.
[77]Weizman ED.Advances in Sleep Research[M].Lancaster:MTP Press,1983:393-400.
[78]RiquDJ,ThaseEM.TreatmentofInsomniaassociatedwithClinicalDepression.SleepMedicine,2004:8:19-30.
[79]蔡焯基.抑郁症基础与临床.科学出版社,63-64。
[80]赵忠新.临床睡眠障碍学.第二军医大学出版社,2003:274-278。
[8]RiquDJ,ThaseEM.TreatmentofInsomniaassociatedwithClinicalDepression.SleepMedicine,2004:8:19-30
[82]Tsuno N,Besset A;Ritchie K.Sleep and depression.J Clin Psychiatry,2005:66:1254-1269
[83]Wirz-Justice A,Van den Hoofdakker RH.Sleep deprivation in depression:vrhat do we known,where do we go? Biol Psychiatry,1999:46:445-453
[84]Kelier MB,Lavori PW,Mueller TI,et al.Time to recovery,chronicity,and levels of psychopathology in major depression:5-year prospective follow-up of 431 subjects.Arch Gen Psychiatry 1992:49:809-816
[85]龚绍麟 抑郁症 人民卫生出版社:267-270
[86]慈书平,张希龙,潘集阳,等.睡眠与睡眠疾病.军事医学科学出版社:128-129
[87]Kessler RC,Berglund P,Demler O,et al.The epidemiology of major depressive disorder:results from the National Comorbidity Survey Replication(NCS-R).JAMA,2003:289:3095-3105
[88]Kupfer DJ,Ehlers CL,Frank E,et al.EEG sleep profiles and recurrent depression.Biol Psychiatry 1991;30:641-655
[89]Dew MA,Reynolds CF Ⅲ,Houck PR,et al.Temporal profiles of the course of depression during treatment:predictors of pathways toward recovery in the elderly.Arch Gen Psychiatry,1997;54:1016-1024
[90]Breslau K,Roth T,Rosenthal L,et al.Sleep disturbance and psychiatric disorders:a longitudinal epidemiological study of young adults.BiolPsychiatry,1996:39:411
[91]Brown LF,Reynolds CF Ⅲ,Monk TH,et al.Social rhythm stability following late-life spousal bereavement:associations with depression and sleep impairment.Psychiatry Res,1996;62:161-169
[92]侯钢,张心保.耿直,等.抑郁症患者REM睡眠研究.临床精神医学杂志,1999;9(1):4-6
[93]邓先华,孙学礼.唐娴.抑郁症睡眠研究进展.华西医学,2006:21(4):849-850
[94]Kupfer DJ,Foster FG Interval between onset of sleep and rapid-eye-movement sleep as an indicator of depression.Lancet,1972,2:684-686
[95]Kupfer DJ.Ram latency:a psychobiologic maker for primary depressive disease.Biol Psychiatry,1976:11:159-174
[96]Lauer CJ,Krieg JC,Garcia-Borreguero D,et al.Panic disorder and major depression:a comparative electroencephalographic sleep study PsychiatryRes,1992;44:41-54
[97]Perils ML,Giles DE,Buysse DJ,et al.Which deressive symptoms are related to which sleep Electroencephalographic variables? BIOLPsychiatry,1997:42,904-913
[98]Benca RM,Obermeyer WH,Thisted RA,et al.Sleep and psychiatric disorders:a metaanalysis.Arch Gen Psychiatry,1992:49:651-668
[99]Lauer CJ,Schreiber W,Holsboer F,et al.In quest of identifying vulnerability markers for psychiatric disorders by all-night polysomnography,Arch Gen Psychiatry,1995;52:145-153
[100]Modell S,Huber J,Holsboer F,et al.The Munich Vulnerability study on Affective disorders:risk factors for unipolarity versus bipolarity.J Affect Disord,2003;74:173-184
[101]贾福军,王雨若,李冲等.快眼动睡眠参数异常与抑郁倾向及抑郁症的关系.新乡医学院学报,1995:12(3):208-211
[102]Webb W,Camobell SS.Relationships in sleep characteristics of identical and fraternal twins.Arch Gen Psychiatry 1983:40:1093-1095
[103]Parkes JD and Lock CB.Genetic factors in sleep disorders.J Neurol Neurosurg Psychiatry 1989:suppl 1:101-108
[104]Kupfer DJ,Roy K,Mitchell P,et al.Two roads to rapid eye movement latency.Arch Gen Psychiatry,1989:46:945-948
[105]Horwath E,Johnson J,Weissman MM,et al.The validity of major depression wish atypical features based on a community study.J Affect Disord,1992:26:117-I 25
[106]Shimizu A,Hiyama H,Yagasaki A,et al.Sleep of depressed patients with hypersomnia:a 24-h polygraphic study.Waking Sleeping,1979:3:335-339
[107]Nofzinger EA,Thaes ME,Reynolds CF Ⅲ,et al.Hypersomnia in bipolar depression:a comparison with narcolepsy using the multiple sleep latency test.Am J Psychiatry,1991:148:1177-1181
[108]GD.Hypersomnia in major depressive disorders.J Affect Disord,1984:6:283-286
[109]慈书平.张希龙,潘集阳,等.睡眠与睡眠疾病.军事医学科学出版社:131-132。
[110]Sandor P,Shapiro CM.Sleep patterns in depression and anxiety:theory and pharmacological effects.J Psychosom Res,1994:38(suppl 1):125-139
[111]Kupfer DJ,Reynolds CF.Sleep and affective disorders,ln:Payke ES,ed.Handbook of Affective Disorders.Edinburgh,Scotland:Churchill Livingstone.1992:311-323
[112]Vogel GW,McAbee R,Barker K,et el.Endogenous depression improvement and REM pressure.Arch Gen Psychiatry,1977:34:96-97
[113]Van Bemmel AL.The link between sleep and depression:the effects of antidepressants on EEG sleep.J Psychosom Res,1997:42:555-564
[114]Sharpley AL,Cowen PJ.Effect of pharmacologic treatments on the sleep of depressed patients.Biol Psychiatry,1995:37:85-98
[115]Kupfer DJ,Ehlers CL,Frank E,et al.Persistent effects of antidepressants:EEG sleep studies in depressed patients during maintenance treatment.Biol Psychiatry,1994:35:781 -793
[116]Vogel GW,Thurmond A,Gibbons P,et al.REM sleep reduction effects on depression syndromes.Arch Gen Psychiatry,1975:32:765-777。
[117]Adrien J.Neurobiological bases for the relation between sleep and depression.Sleep Med Rav,2002:6:341-351
[118]喻东山,张心保,侯钢,等.抑郁症的睡眠脑电图与人脑兴奋守恒假说.神经疾病与精神卫生,2004;4(1):13-14
[119]Chang PP,Ford DE,Mead LA,et al.Insomnia in young men and subsequent depression:the Johns Hopkins Precursors Study.Am J Epidemiol,1997,146:105-114
[120]Riqu DJ,Thase EM.Treatment of Insomni aassociated with Clinical Depression.Sleep Medicine,2004:8:19-30.
[121]Tsuno N,Besset A;Ritchie K.Sleep and depression.J Clin Psychiatry,2005:66:1254-1269
[122]赵忠新.临床睡眠障碍学.第二军医大学出版社,2003;274-278
[123]李晓白,黄继忠,王祖承.抑郁症与谷氨酸传导.中国新药与临床杂志,2005;24(8):601-604
[124]郝伟,江开达.《精神病学》(第5版).人民卫生出版社:214
[125]中华医学会编著.主编张明园,周东丰 施慎逊.临床技术操作规范.精神病学分册人民军医出版社:8-9
[126]国际神经精神药理学会特别工作组 特别工作组主要成员:Norman Sarzorius(主席) Thomas C.Baghai Dayid Stewart Baldwin,中方工作组主要成员:肖泽萍,于欣,徐一峰.抑郁障碍的药物治疗-扰抑郁药物使用和有效性评估.人民卫生出版社:26-27。
[127][英]KirbyS.运动对治疗临床抑郁症的正面效应.NursTimes,2005;101(13):28-29
[128]马彦.健身运动对心理疾病治疗的研究.吉林体育学院学报,2006:2(3):80-81
[129][英]/KirbyS.运动对治疗临床抑郁症的正面效应.Nuts Times,2005;101(13):28-29
[130]Riqu DJ,Thase EM Treatment of Insomni aassociated with Clinical Depression.Sleep Medicine,2004;8:19-30
[131]赵忠新,夏斌,贺斌.专家解答失眠症.上海科学技术文献出版社:76-77
[132]慈书平,张希龙,潘集阳,等.睡眠与睡眠疾病.军事医学科学出版社:131-132
[133]7.ArthurJ,SpielmanJ,NunesP:Insomnia.Neurologic Clinic,1996,14(3):513-543.
[134]Feighner J,Bover W.Overview of USA controlled trials of trvzodone in clinical depression.Psychophar macolog tnacolog1988;95(1):50.
[135]Editorial:Trazodone as a hypnotic in major depression.Sleep Medicine,2004;5:7-8.
[136]赵忠新主编.临床睡眠障碍学.第二军医大学出版社,2003:274-278
[137]Ruth B,Sonia IA,Harvey M:Special consideration in insomnia diagnosis and management:depressed,elderly,and chronic pain populations.J Clinic Psychiatry,2004;65(suppl8):26-33.
[138]Editorial:Trazodone as a hypnotic in major depression.Sleep Medicine,2004;5:7-8
[139]JorisV,DieuwkeV,EdmundV.Residual effects of sleep Medication on driving ability.Sleep Medicine,2004;8:309-325.
[140]Mouret J,lemoine P,Minuit M,etal.Effects of trazodone On the sleep of depressed subjects a polygraphic study.Psychopharmacology,1998;95(1):37
[141]Andrew D,Krystal D.The Changing Perspective on Chronic Insomnia Management.J ClinicPsychiatry,2004;65(suppl 8):20-24.
[142]李广智,严和骏,徐韬园,等.《名医会诊·抑郁症》.上海文化出版社:130-131
[143]郝伟,江开达.《精神病学》(第5版).人民卫生出版社:82
[1]王玲玲,张建斌.针药结合治疗抑郁症的临床现状与研究前景.南京中医药大学学报,2006,3月,22(2):130-133
[2]Riqu.D.J,Thase EM.Treatment.of.Insomnia.associated with ClinicalDepression.Sleep Medicine,2004:8:19-30.
[3]张建斌,王玲玲.针刺治疗抑郁症机理研究进展上海针灸杂志.2006,12月,25(12):44-46
[4]张平根,康波,钟旗等.电针与阿米替林治疗抑郁症的对照观察.江西中医药,2002,33(3):62-63
[5]董子平.电针治疗抑郁症101例.中国针灸,2001,21(1):630-631
[6]王玉英.针灸治疗抑郁症.国外医学中医中药分册,1994,16(6):50-52
[7]杨秀娟,刘向,罗和春.针刺奇经穴为主治疗抑郁症临床观察.中医杂志,1992,(3):36-37
[8]侯冬芬,罗和春.电针百会印堂治疗30例中风后抑郁患者临床疗效观察.中国针灸,1996,(8):23-24
[9]林虹.电针治疗产后精神障碍抑郁型30例疗效观察.天津中医,1996,13(3):11-13
[10]朱明娟.针剌百会穴、外敷涌泉穴治疗失眠症50例[J].中国冶金工业医学杂志,2000,17(4):256.
[11]陈光.抑郁症神经内分泌功能及其对电针治疗反映的研究.北京医科大学学报,1992,24(5):401
[12]陈文垲,周玲,梅晓云等.从临床流行病学调查探讨抑郁症中医病机规律[J].南京中医药大学学报,2005,21(5):273-276
[13]刘兰英,王玲玲.“脑为元神之府”理论在针灸治疗抑郁症中的指导意义.针灸临床杂志,2003,19(8):6-8
[14]王玲玲,刘兰英,吕梅等.针灸治疗抑郁症临床思路.针灸临床杂志2003,19(7):7-9
[15]宋媛,赵仓焕,朱小华·从督脉论治失眠症[J]·四川中医,2005,23(12):11-12
[16]周莉.针刺百会穴对记忆影响的实验观察.黑龙江中医药,1992,(3):41
[17]洪文学,樊凤杰,宋佳霖.百会穴研究概况 上海针灸杂志,2006 2月,25(2):42-45
[18]白耀辉,林文任.艾灸与温热刺激关系的探讨.针灸学报1991:7(4):10
[19]杨华元,刘堂义.艾灸疗法的生物物理机制初探.中国针灸1996:16(10):17
[20]吴焕淦 施茵 东红升 张仁 灸法研究的思考与体会 针灸技术规范及学术发展研讨会论文集。
[21]史玉泉·实用神经病学[M]·第2版·上海:上海科学技术出版社,1995:1124-1226.
[22]李滋平·针灸百会、神庭穴为主治疗失眠症110例临床观察[J]·针灸临床杂志,2006,22(9):39
[23]陈峰·耳穴神门对脑动脉硬化症患者椎-基底动脉血流的即时作用观察[J]·中国针灸1997:19
[24]严兴强.灸百会穴治疗顽固性失眠49例疗效观察[J].针灸临床杂志,1999:15(5):37
[25]徐宓宓.艾灸治疗失眠79例[J).实用中医药杂志,2001:17(10):37
[26]范郁山,姚春.温针灸法治疗失眠37例(J).陕西中医,2003:24(2):164
[27]赵永祥.灸百会涌泉穴治疗失眠30例(J).云南中医中药杂志,1996,(2):47
[28]孟云凤.艾灸百会治疗神经衰弱(J).针刺研究,1997,(3):208
[29]孙开明,唐在莲.针刺加艾条治疗失眠60例报告(J).职业与健康,2005:21(2):281
[2]杨坤.指导:谢光荣教授.S100B基因多态性与抑郁症发病的关联及抑郁症睡眠脑电生理特征的探讨(博士学位论文).中南大学,2007年5月
[3]舒良.抑郁症的评定与治疗.中华医学杂志,1999;79(5):398-400
[4]牟君.指导教师姓名:谢鹏教授.抑郁症的脑功能磁共振和蛋白组学研究(重庆医科大学博士学位论文),2007年6月
[5]新加坡联合早报.2007年09月10日:7
[6]亢明.34例抑郁症患者睡眠障碍临床分析.临床精神医学杂志,1998;8(4):213-214
[7]王祖承.难治性精神疾病.上海科学技术出版社,2007:157-158
[8]施建安,王版,焕林.失眠症的研究进展.中华神经精神科杂志,1994;22(5):287
[9]李晓白,黄继忠,王祖承.抑郁症与谷氨酸传导.中国新药与临床杂志,2005:24(8):601-604
[10]罗和春,沈渔邨,贾云奎,等.电针治疗133例抑郁症患者临床疗效观察[J].中西医结合杂志,1988;8(2):77
[11]刘兰英 王玲玲.“脑为元神之府”理论在针灸治疗抑郁症中的指导意义.针灸临床杂志,2003;19(8):6-8
[1]中国中西医结合研究会精神病专业委员会.躁郁证的中西医结合辨证分型标准[J].中西医结合杂志,1998;8(2):127-128
[2]姜劲峰,王玲玲,王俊,等.抑郁症从升降理论辨证的探讨.中国中医基础医学杂志,2006:第12(8):598-599
[3]卫永琪.中医辨证治疗老年抑郁症[J].四川中医,2004;22(12):44-45
[4]吕红艳.辨证论治抑郁症疗效观察[J].广西中药,2002;25(2):14-16
[5]苏根.辨证施治老年抑郁症30例[J].中医研究,2004;17(1):45-46
[6]张金茹.小柴胡汤治疗抑郁症40例[J].北京中医,2003,22(5):38-39
[7]唐启盛,侯德明,陈密文,等.颐脑解郁法治疗轻、中度抑郁症的开放性临床研究[J].中国临床康复,2002:6(21):3207
[8]杨进,谢忠礼,沈炳章,等.菖欢胶囊治疗抑郁性神经症临床观察[J].南京中医药大学学报(自然科学版),2003,19(2):78-80
[9]金杰,陈海燕,赵铎,等.加味百合地黄汤治疗抑郁性神经症35例[J].山西中医,2001:17(2):21
[10]刘黎明.补达饮治疗抑郁症40例[J].陕话中医,2004;25(10):876-877
[11]王天俊.针刺治疗抑郁症临床观察[J].中国针灸,2005;25(2):107-108
[12]尹秀茹.电针治疗抑郁症30例临床观察[J].河北中医,2005;27(7):527-528
[13]江小荣.芒针治疗抑郁症47例临床观察[J].中医药学刊,2003;21(9):1567-1568
[14]张丹莉.针刺在抑郁症患者中的应用[J].中匡临床康复,2005:9(20):217
[15]唐胜修,徐祖豪,唐萍,等.针刺治疗抑郁性神经症的临床研究[J].中国针灸,2003;23(10):585-586
[16]吕梅,王玲玲.针刺治疗抑郁症选穴频次的分析.针灸临床杂志,2003;19(8):15
[17]罗和春.新电针疗法治疗抑郁症研究进展的启示.中国中话医结合杂志,2000;20(11):806-807
[18]韩毳,罗和春,李晓泓,等.电针与麦普替林治疗抑郁症患者的对照研究.中国中西医结合杂志,2002:22(7):512-514.
[19]任建宁.耳针治疗抑郁症50例.河南中医,2005;25(2):75.
[20]李德平,王宝玲.腹针治疗抑郁症44例.上海针灸,2005:24(3):22.
[21]黄泳,夏东斌.头电针治疗抑郁症30例临床观察.中西医结合学报,2004;,2(2):151-160.
[22]黄庆元,李建国.中国道家认知疗法治疗抑郁症35例临床观察.甘肃中医,2005:9(18):18-19.
[23]张国泰.浅谈张子和的情志疗法.光明中医,2000;15(6):38-39
[24]胡永年.略谈以情胜情疗法.湖北中医杂志,2000;22(7):9-10
[25]周庆.中医治疗抑郁症.医学综述,2003:9(5):316-317
[26]武丽,张丽萍,叶庆莲,等.加减温胆汤对抑郁模型大鼠行为学和血浆生长抑素含量的影响.中国临床康复,2005:9(8):114-116.
[27]薛征.脾肾两助丸抗抑郁作用的实验研究.山西中医学院学报,2003:4(4):14-16
[28]冯文林.抑郁症的中医药实验研究概况.浙江中医杂志,2002:11:502-503
[29]傅强,马世平.半夏厚朴汤抗抑郁作用的研究.中国药科大学学报,2002:33(6):514-517
[30]何咏梅,杜绍礼.抗抑郁中药的研究进展.湖南中医药导报,2003:9(6):71-73
[31]陈瑶,秦路平.积雪草总苷对抑郁症大鼠神经内分泌功能的影响.第二军医大学学报,2002;23(11):1224-1226
[32]司银楚,孙建宁.贯叶连翘提取物对慢性应激抑郁大鼠行为及脑内5-HT,NE表达的影响.中国医科大学学报,2003;34(1):70-73
[33]李作平,赵丁,任雷鸣,等.合欢花抗抑郁作用的药理实验研究初探.河北医科大学学报,2003;24(4):214-216
[34]冯文林.抑郁症的中医药实验研究概况.浙江中医杂志,2002:11:502-503
[35]俞瑾,李晓艳,曹小定,等.电针合用抗抑郁药能明显减少小鼠强迫游泳实验中的静止时间.针刺研究,2002:27(2):119-123.
[36]李文迅,韩焱晶,隋娟,等.电针对抑郁模型大鼠海马神经元凋亡的影响.中国中医药信息杂志,2005:12(2):33-35.
[37]徐云生.邓铁涛教授治疗失眠的经验.新中医,2000;32(6):5
[38]邓红,王多让.从气血论治失眠症经验.实用中医药杂志,2000;16(5):37
[39]吕春芳,解静.吕同杰治疗顽固性失眠经验.山东中医杂志,2000;19(5):301
[40]毛海燕,张珍玉.辨治失眠经验.山东中医杂志,2002:21(6):369
[41]周恩庆.安魂定志汤治疗失眠证例临床观察.中国中医基础医学杂志,2002;8(1):31
[42]张根明,宋琪,张章.抑郁障碍相关性失眠的临床特点及中医证候分布情况初步研究.北京中医药大学学报(中医临床版),2008:15(1)Pg12-14
[43]中华医学会精神科分会.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,2001:87-88
[44]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:19-20
[45]贺建华,张茁.失眠的诊断[J].中国全科医学,2006:9(8):619-620
[46]失眠定义、诊断及药物治疗共识专家组.失眠定义、诊断及药物治疗专家共识(草案)[J].中华神经科杂志,2006:39(2):141-143
[47]汪向东,王希林,马弘,等.心理卫生评定量表手册(增订版)rM].北京:中国心理卫生杂志社,1999:375-378
[1]房玉新编辑.打破高患病率与低识别率之间矛盾的坚冰--就抑郁症与周东丰教授一席谈.中华医学杂志,1999;79(5):398-400
[2]张宝华.抑郁症认知功能障碍的研究进展中国慢性病预防与控制.2006:(8):298-300
[3]袁浩龙.抑郁症病因的神经内分泌学研究进展.临床精神医学杂志,1995;5(6):365-367
[4]沈渔邨.精神病学[M].第3版.北京:人民卫生出版社,1994:631。
[5]王祖新.抑郁症的病因学研究中华内科杂志.1998;37(8):568
[6]Schildkraut JJ.The catecholamine hypothesis of affective disorders:a review of supporting evidence.Am J Psychiatry.1965:122:509-512,
[7]MarazzitiD,Baronis:MasalaI,etal.correlationbetweenplateletalpha(2)Adrenoreceptors and symptom severity in major De-pression[J].Neuropsychobiology,2001:44:122-125.
[8]Coppen A.,Shaw DM.,Mallerson A.Changes in 5-hydroxy-tryptophan metabolism in depression.Brit S Psychiat 1965:111
[9]Pandey GN.Altered serotonin function in suicide:Evldence from platelet and neuroendocine studies.Ann N Y Acad Sci,1997:836:182,
[10]吕路线,宋景贵,卢红,等.卒中后抑郁状态患者的血浆,脑脊液单胺神经递质测定.[J]中华精神科杂志;2000,33(1):29-32.
[11]Yatham LN,liddle PF,shiah Is,et al.Brain serotoninz receptorsin major depression:a positron emission tomography study[J].Arch gen Psychiatry,2000:57:850-8.
[12]Mann JJ,HuangYY,underwood MD,et al.Aserotonin trans-porter gene promoter polymorphism(5-HTTLPR)and prefron-talcortical binding in major depression and suicide[J].ArchGen Psychiatry,2000;57:729-738.
[13]潘桂花,林治光,徐韬园,等.抑郁症患者血小板五羟色胺浓度的研究.上海精神医学,2005;17(3):145-147。
[14]王祖新.抑郁症的病因学研究.中华内科杂志,1998;37(8):568
[15]潘玉芹,林文娟.海马52羟色胺系统与抑郁症.中国行为医学科学.2006;15,4:379-380
[16]Willner P.Dopamine and depression:A review of recent evidence.Brain Res.Rev.1983;6:211-246
[17]Bowden C,Theodorou AE,Cheetham SC,et al、 Dopamine D1 and D2 receptor binding sites in brain samples from depressed suicides and controis.Brain Res.1997:752:227-233.
[18]Steffens DC,Byrum CE,McQuoid DR et al.Hippocampal volume in geriatric depression.Biol Psychiat,2000;48:301-309,
[19]Krystal JH,Petraki s IL,D' Souza DC,et al.Interactive effects of high dose intravenous glycine and oral D-cycloserine in healthy human subjects.Biol Psychiat,1997;41(Suppl):
[20]MAURIMC,etal.Neuropsychobiology,1998;37:124-129,
[21]Sanacora G,Mason GF,Rothman DL,et al,Reduced cortical GABA levels in depressed patients determined by 1 H-magnetic resonance spectroscopy[J].Arch Gen Psychiat,1999;56:1043-1047,
[22]张黎明,李云峰,宫泽辉.神经元再生:抑郁症治疗的新策略[J].生理科学进展,2005:36(2):109=112。
[23]李晓照,陈泽奇,胡随瑜,等.抑郁症患者血清BDNF水平与相关因素分析.中匡临床心理学杂志,2005;13(3):312-313
[24]mitchell AJ.The role of corticotropin releasing factor in depres-sive illness:a criticalreview[J].neurosciBiobehavRev,1998,22(5):635-741.
[25];steogersteogerA,holsboer F.nocturnal secretion of prolactin and corti-sol and the sleep BCG in patients with mjor endogenous depres-sion during an acute episode and after full remission[J].Psychia-try Res,1997,72(2):81-87.
[26]刘健.抑郁症和阿尔采木氏病的HPA轴功能[J].国外医学#精神病学分册,1997:24(2):119-120。
[27]崔青,侯钢,孙静,等.抑郁症晨重夕轻特征与生物学的关系.临床精神医学杂志,2006;16(5):266-268
[28]WATSON SJ.Biology of schizophrenia and affective disease[J].London:American Psychiatric press,1996:259.
[29]许绍芬.神经生物学[M].上海医科大学出版社:1990:228.
[30]Rubinow DR,schmidt PJ,Roca CA.Estrogen-serotonin inter- actions:Implications for affective regulation[J].Biol psychia- try,1998:44(5):799-811.
[31]李强,尚翠侠,马现仓,等.抑郁症患者的性激素分析[J].中匿神经精神疾病杂志,1999:25(5):271-273.
[32]Horsten M,WamalaSP,VingerhoetsA,et al.Depressive symp toms and support and lipid Profile in healthy niddle aged women[J].PsychosomMed,1997:59(5):521
[33]赵汉清,崔庶,端义扬,等.低血清胆匿醇与女性抑郁症的自杀行为[J].中国神经精神疾病杂志,2000;26(2):78-80.
[34]何舒,林渝峰,李霞.抑郁症的发病机制研究进展.四川生理科学杂志,2006;28(3):123-128
[35]郭新胜,许明智,师天元.内源性抑郁症患者存在脂质代谢异常.第三属全国临床检验实验室管理学术会议:229-230
[36]何舒,林渝峰,李霞.抑郁症的发病机制研究进展.四川生理科学杂志,2006:28(3):123-128
[37]骆晓林,陈昌惠,李淑然,等.45岁以上抑郁病人与正常人理!免疫功能的比较研究[J].中国临床心理杂志,1997;5(2):83-86
[38]王长虹,周东丰,管振权.抑郁症患者治疗前后认知、内分泌、细胞因子的变化.中国心理卫生杂志,2006;20(7):434-436
[39]苏晖,江开达.抑郁症的认知功能障碍.上海精神医学,2006;18(4):244-245
[40]武力勇,魏镜,李舜伟.抑郁症患者伴发认知功能损害的研究进展.中华精神科杂志,2004;37(3):188-189
[41]张宝华.抑郁症认知功能障碍的研究进展.中国慢性病预防与控制.2006;(8):298-300
[42]苏晖,江开达.抑郁症的认知功能障碍.上海精神医学2006;18(4):244-245
[43]喻东山.抑郁症的神经解剖基础.国外医学精神病学分册,1995;22(2):107-109
[44]Krishnan KR,Hays JC,Blazer DG.MRI-defined vascular depression.Am J Psychiat.1997;154:497-541.
[45]Macfall JR,Payne ME,Provenzale JE,et al.Medial orbital frontal lesions in lateonset depression.Biol Psychiat.2001;49:803-806.
[46]brevets WC,Price JL,Simpson JR Jr,et al.Subgenual prefrontal cortex abnormalities in mood disorders.Nature.1997;386:824-827.
[47]Drevets WC.Functional anatomical abnormalities in limbic and prefrontal cortical structures in major depression.Prog BrainRes.2000;126:413-431.
[48]Rajkowska G,Miguel-Hidalgo JJ,Wei J,et al.Morphometric evidence for neuronal and glial prefrontal cell pathology in major depression.Biol Psychiat.1999:45:1085-1098.
[49]Kumar A,Thorns A,Laxetsky H,et al.Frontal white matter biochemical abnormalities in late-life major depression detected with proton magnetic resonance spectroscopy.Am J Psychiatry.2002;159:630-639
[50]Coffey CE,Figiei GS,Djang WT,Saunders WB,Weiner RD.White matter hyperintensity on magnetic resonance imaging:clinical and neuroanatomic correlates in the depressed elderly.J.Neuropsychiat.Clin.Neurosci.1989:1:135-144.,
[51]Krishnan KR,Hays JC,Blazer DG MRI-defined vascular depression.Am.J.Psychiat.1997;154:497-501.
[52]MacFall JR,Payne ME,Provenzale JE,Krishnan KR.Medlal orbital frontallesions in lateonset depression.Biol.Psychiat.2001:49:803-806.
[53]林文娟.精神与免疫.见:21世纪初科学发展趋势课题组编《.21世纪100个科学难题》.吉林出版社,1998;693-701
[54]宏宇,林文娟.白细胞介素-1在病态行为中的作用及其机理.心理科学进展,2004;12(2):290-295
[55]何舒,林渝峰,李霞.抑郁症的发病机制研究进展.四川生理科学杂志,2006;28(3)Pg123-128
[56]陈斌贝,周斌,詹秀琴.药物免疫促进剂与抑郁症相关性探讨.浙江中西医结合杂志,2006;16(7):455-456
[57]汪春运.抑郁症的躯体症状.《临床荟萃》,2006;5,21(9):670-671
[58]王祖新.抑郁症的病因学研究.中华内科杂志,1998;8,137(8):568
[59]诊断及药物治疗共识专家组.失眠定义,诊断及药物治疗专家共识(草案)[J].中华神经科杂志,2006;39(2):141-143
[60]慈书平,张希龙,杨宇,等.睡眠与睡眠疾病.军事医学科学出版社130-133
[61]陈圣祺,李广智.《名医会诊·失眠症》上海文化出版社:5
[62]翁思琪.神经生物学原理.北京医科大学出版社,1999:4
[63]贾永蕊,胡然,库宝善.几种常见精神疾患的睡眠障碍.国外医学精神病学分册,2003 30(2):111-113
[64]陈圣祺,李广智.《名医会诊·失眠症》.上海文化出版社,6-7
[65]龚绍麟.抑郁症.人民卫生出版社,267-270。
[66]杨本付,张作记,岳喜同.医学生睡眠质量与焦虑抑郁情绪关系的探讨.中国行为医学科学1999;9(5):346-347.
[67]Ford DE.Frame row DB Epidemiological study of sleep disturbance and psychiatric disorders.JAMA 1989:262:1479
[68]Chang PP,Ford DE,Mead LA,et al.Insomnia in young men and subsequent depression:the Johns Hopkins Precursors Study.Am J Epidemiol,1997:146:105-114
[69]张希龙,杨宇,潘集阳,等.睡眠与睡眠疾病.军事医学科学出版社,129。
[70]王健.睡眠医学的研究.中国临床康复,2004;8(3):544-546
[71]余海鹰.抑郁症睡眠障碍研究新进展.国外医学·精神病学分册,1999;26(3),138-140
[72]唐启盛.郁症中西医基础与临床.中国中医药出版社,138
[73]BenaRMBenaRM,ObermeyerWH,Thistec,eta.lSleepandpsychiat-ricdisorder:ameta-analysis.ArchGenPsychiatry,1992,49:651-668
[74]余海鹰,崔庶,王宏,等.抑郁症患者睡眠行为及睡眠生理障碍的研究(J1.中华精神科杂志,2000:33(1):23-5
[75]沈渔邨.神经生理学原理.北京:医科大学出版社,1999;1132-1142.
[76]亢明.34例抑郁症患者睡眠障碍临床分析.临床精神医学杂志,1998;8(4):213-214.
[77]Weizman ED.Advances in Sleep Research[M].Lancaster:MTP Press,1983:393-400.
[78]RiquDJ,ThaseEM.TreatmentofInsomniaassociatedwithClinicalDepression.SleepMedicine,2004:8:19-30.
[79]蔡焯基.抑郁症基础与临床.科学出版社,63-64。
[80]赵忠新.临床睡眠障碍学.第二军医大学出版社,2003:274-278。
[8]RiquDJ,ThaseEM.TreatmentofInsomniaassociatedwithClinicalDepression.SleepMedicine,2004:8:19-30
[82]Tsuno N,Besset A;Ritchie K.Sleep and depression.J Clin Psychiatry,2005:66:1254-1269
[83]Wirz-Justice A,Van den Hoofdakker RH.Sleep deprivation in depression:vrhat do we known,where do we go? Biol Psychiatry,1999:46:445-453
[84]Kelier MB,Lavori PW,Mueller TI,et al.Time to recovery,chronicity,and levels of psychopathology in major depression:5-year prospective follow-up of 431 subjects.Arch Gen Psychiatry 1992:49:809-816
[85]龚绍麟 抑郁症 人民卫生出版社:267-270
[86]慈书平,张希龙,潘集阳,等.睡眠与睡眠疾病.军事医学科学出版社:128-129
[87]Kessler RC,Berglund P,Demler O,et al.The epidemiology of major depressive disorder:results from the National Comorbidity Survey Replication(NCS-R).JAMA,2003:289:3095-3105
[88]Kupfer DJ,Ehlers CL,Frank E,et al.EEG sleep profiles and recurrent depression.Biol Psychiatry 1991;30:641-655
[89]Dew MA,Reynolds CF Ⅲ,Houck PR,et al.Temporal profiles of the course of depression during treatment:predictors of pathways toward recovery in the elderly.Arch Gen Psychiatry,1997;54:1016-1024
[90]Breslau K,Roth T,Rosenthal L,et al.Sleep disturbance and psychiatric disorders:a longitudinal epidemiological study of young adults.BiolPsychiatry,1996:39:411
[91]Brown LF,Reynolds CF Ⅲ,Monk TH,et al.Social rhythm stability following late-life spousal bereavement:associations with depression and sleep impairment.Psychiatry Res,1996;62:161-169
[92]侯钢,张心保.耿直,等.抑郁症患者REM睡眠研究.临床精神医学杂志,1999;9(1):4-6
[93]邓先华,孙学礼.唐娴.抑郁症睡眠研究进展.华西医学,2006:21(4):849-850
[94]Kupfer DJ,Foster FG Interval between onset of sleep and rapid-eye-movement sleep as an indicator of depression.Lancet,1972,2:684-686
[95]Kupfer DJ.Ram latency:a psychobiologic maker for primary depressive disease.Biol Psychiatry,1976:11:159-174
[96]Lauer CJ,Krieg JC,Garcia-Borreguero D,et al.Panic disorder and major depression:a comparative electroencephalographic sleep study PsychiatryRes,1992;44:41-54
[97]Perils ML,Giles DE,Buysse DJ,et al.Which deressive symptoms are related to which sleep Electroencephalographic variables? BIOLPsychiatry,1997:42,904-913
[98]Benca RM,Obermeyer WH,Thisted RA,et al.Sleep and psychiatric disorders:a metaanalysis.Arch Gen Psychiatry,1992:49:651-668
[99]Lauer CJ,Schreiber W,Holsboer F,et al.In quest of identifying vulnerability markers for psychiatric disorders by all-night polysomnography,Arch Gen Psychiatry,1995;52:145-153
[100]Modell S,Huber J,Holsboer F,et al.The Munich Vulnerability study on Affective disorders:risk factors for unipolarity versus bipolarity.J Affect Disord,2003;74:173-184
[101]贾福军,王雨若,李冲等.快眼动睡眠参数异常与抑郁倾向及抑郁症的关系.新乡医学院学报,1995:12(3):208-211
[102]Webb W,Camobell SS.Relationships in sleep characteristics of identical and fraternal twins.Arch Gen Psychiatry 1983:40:1093-1095
[103]Parkes JD and Lock CB.Genetic factors in sleep disorders.J Neurol Neurosurg Psychiatry 1989:suppl 1:101-108
[104]Kupfer DJ,Roy K,Mitchell P,et al.Two roads to rapid eye movement latency.Arch Gen Psychiatry,1989:46:945-948
[105]Horwath E,Johnson J,Weissman MM,et al.The validity of major depression wish atypical features based on a community study.J Affect Disord,1992:26:117-I 25
[106]Shimizu A,Hiyama H,Yagasaki A,et al.Sleep of depressed patients with hypersomnia:a 24-h polygraphic study.Waking Sleeping,1979:3:335-339
[107]Nofzinger EA,Thaes ME,Reynolds CF Ⅲ,et al.Hypersomnia in bipolar depression:a comparison with narcolepsy using the multiple sleep latency test.Am J Psychiatry,1991:148:1177-1181
[108]GD.Hypersomnia in major depressive disorders.J Affect Disord,1984:6:283-286
[109]慈书平.张希龙,潘集阳,等.睡眠与睡眠疾病.军事医学科学出版社:131-132。
[110]Sandor P,Shapiro CM.Sleep patterns in depression and anxiety:theory and pharmacological effects.J Psychosom Res,1994:38(suppl 1):125-139
[111]Kupfer DJ,Reynolds CF.Sleep and affective disorders,ln:Payke ES,ed.Handbook of Affective Disorders.Edinburgh,Scotland:Churchill Livingstone.1992:311-323
[112]Vogel GW,McAbee R,Barker K,et el.Endogenous depression improvement and REM pressure.Arch Gen Psychiatry,1977:34:96-97
[113]Van Bemmel AL.The link between sleep and depression:the effects of antidepressants on EEG sleep.J Psychosom Res,1997:42:555-564
[114]Sharpley AL,Cowen PJ.Effect of pharmacologic treatments on the sleep of depressed patients.Biol Psychiatry,1995:37:85-98
[115]Kupfer DJ,Ehlers CL,Frank E,et al.Persistent effects of antidepressants:EEG sleep studies in depressed patients during maintenance treatment.Biol Psychiatry,1994:35:781 -793
[116]Vogel GW,Thurmond A,Gibbons P,et al.REM sleep reduction effects on depression syndromes.Arch Gen Psychiatry,1975:32:765-777。
[117]Adrien J.Neurobiological bases for the relation between sleep and depression.Sleep Med Rav,2002:6:341-351
[118]喻东山,张心保,侯钢,等.抑郁症的睡眠脑电图与人脑兴奋守恒假说.神经疾病与精神卫生,2004;4(1):13-14
[119]Chang PP,Ford DE,Mead LA,et al.Insomnia in young men and subsequent depression:the Johns Hopkins Precursors Study.Am J Epidemiol,1997,146:105-114
[120]Riqu DJ,Thase EM.Treatment of Insomni aassociated with Clinical Depression.Sleep Medicine,2004:8:19-30.
[121]Tsuno N,Besset A;Ritchie K.Sleep and depression.J Clin Psychiatry,2005:66:1254-1269
[122]赵忠新.临床睡眠障碍学.第二军医大学出版社,2003;274-278
[123]李晓白,黄继忠,王祖承.抑郁症与谷氨酸传导.中国新药与临床杂志,2005;24(8):601-604
[124]郝伟,江开达.《精神病学》(第5版).人民卫生出版社:214
[125]中华医学会编著.主编张明园,周东丰 施慎逊.临床技术操作规范.精神病学分册人民军医出版社:8-9
[126]国际神经精神药理学会特别工作组 特别工作组主要成员:Norman Sarzorius(主席) Thomas C.Baghai Dayid Stewart Baldwin,中方工作组主要成员:肖泽萍,于欣,徐一峰.抑郁障碍的药物治疗-扰抑郁药物使用和有效性评估.人民卫生出版社:26-27。
[127][英]KirbyS.运动对治疗临床抑郁症的正面效应.NursTimes,2005;101(13):28-29
[128]马彦.健身运动对心理疾病治疗的研究.吉林体育学院学报,2006:2(3):80-81
[129][英]/KirbyS.运动对治疗临床抑郁症的正面效应.Nuts Times,2005;101(13):28-29
[130]Riqu DJ,Thase EM Treatment of Insomni aassociated with Clinical Depression.Sleep Medicine,2004;8:19-30
[131]赵忠新,夏斌,贺斌.专家解答失眠症.上海科学技术文献出版社:76-77
[132]慈书平,张希龙,潘集阳,等.睡眠与睡眠疾病.军事医学科学出版社:131-132
[133]7.ArthurJ,SpielmanJ,NunesP:Insomnia.Neurologic Clinic,1996,14(3):513-543.
[134]Feighner J,Bover W.Overview of USA controlled trials of trvzodone in clinical depression.Psychophar macolog tnacolog1988;95(1):50.
[135]Editorial:Trazodone as a hypnotic in major depression.Sleep Medicine,2004;5:7-8.
[136]赵忠新主编.临床睡眠障碍学.第二军医大学出版社,2003:274-278
[137]Ruth B,Sonia IA,Harvey M:Special consideration in insomnia diagnosis and management:depressed,elderly,and chronic pain populations.J Clinic Psychiatry,2004;65(suppl8):26-33.
[138]Editorial:Trazodone as a hypnotic in major depression.Sleep Medicine,2004;5:7-8
[139]JorisV,DieuwkeV,EdmundV.Residual effects of sleep Medication on driving ability.Sleep Medicine,2004;8:309-325.
[140]Mouret J,lemoine P,Minuit M,etal.Effects of trazodone On the sleep of depressed subjects a polygraphic study.Psychopharmacology,1998;95(1):37
[141]Andrew D,Krystal D.The Changing Perspective on Chronic Insomnia Management.J ClinicPsychiatry,2004;65(suppl 8):20-24.
[142]李广智,严和骏,徐韬园,等.《名医会诊·抑郁症》.上海文化出版社:130-131
[143]郝伟,江开达.《精神病学》(第5版).人民卫生出版社:82
[1]王玲玲,张建斌.针药结合治疗抑郁症的临床现状与研究前景.南京中医药大学学报,2006,3月,22(2):130-133
[2]Riqu.D.J,Thase EM.Treatment.of.Insomnia.associated with ClinicalDepression.Sleep Medicine,2004:8:19-30.
[3]张建斌,王玲玲.针刺治疗抑郁症机理研究进展上海针灸杂志.2006,12月,25(12):44-46
[4]张平根,康波,钟旗等.电针与阿米替林治疗抑郁症的对照观察.江西中医药,2002,33(3):62-63
[5]董子平.电针治疗抑郁症101例.中国针灸,2001,21(1):630-631
[6]王玉英.针灸治疗抑郁症.国外医学中医中药分册,1994,16(6):50-52
[7]杨秀娟,刘向,罗和春.针刺奇经穴为主治疗抑郁症临床观察.中医杂志,1992,(3):36-37
[8]侯冬芬,罗和春.电针百会印堂治疗30例中风后抑郁患者临床疗效观察.中国针灸,1996,(8):23-24
[9]林虹.电针治疗产后精神障碍抑郁型30例疗效观察.天津中医,1996,13(3):11-13
[10]朱明娟.针剌百会穴、外敷涌泉穴治疗失眠症50例[J].中国冶金工业医学杂志,2000,17(4):256.
[11]陈光.抑郁症神经内分泌功能及其对电针治疗反映的研究.北京医科大学学报,1992,24(5):401
[12]陈文垲,周玲,梅晓云等.从临床流行病学调查探讨抑郁症中医病机规律[J].南京中医药大学学报,2005,21(5):273-276
[13]刘兰英,王玲玲.“脑为元神之府”理论在针灸治疗抑郁症中的指导意义.针灸临床杂志,2003,19(8):6-8
[14]王玲玲,刘兰英,吕梅等.针灸治疗抑郁症临床思路.针灸临床杂志2003,19(7):7-9
[15]宋媛,赵仓焕,朱小华·从督脉论治失眠症[J]·四川中医,2005,23(12):11-12
[16]周莉.针刺百会穴对记忆影响的实验观察.黑龙江中医药,1992,(3):41
[17]洪文学,樊凤杰,宋佳霖.百会穴研究概况 上海针灸杂志,2006 2月,25(2):42-45
[18]白耀辉,林文任.艾灸与温热刺激关系的探讨.针灸学报1991:7(4):10
[19]杨华元,刘堂义.艾灸疗法的生物物理机制初探.中国针灸1996:16(10):17
[20]吴焕淦 施茵 东红升 张仁 灸法研究的思考与体会 针灸技术规范及学术发展研讨会论文集。
[21]史玉泉·实用神经病学[M]·第2版·上海:上海科学技术出版社,1995:1124-1226.
[22]李滋平·针灸百会、神庭穴为主治疗失眠症110例临床观察[J]·针灸临床杂志,2006,22(9):39
[23]陈峰·耳穴神门对脑动脉硬化症患者椎-基底动脉血流的即时作用观察[J]·中国针灸1997:19
[24]严兴强.灸百会穴治疗顽固性失眠49例疗效观察[J].针灸临床杂志,1999:15(5):37
[25]徐宓宓.艾灸治疗失眠79例[J).实用中医药杂志,2001:17(10):37
[26]范郁山,姚春.温针灸法治疗失眠37例(J).陕西中医,2003:24(2):164
[27]赵永祥.灸百会涌泉穴治疗失眠30例(J).云南中医中药杂志,1996,(2):47
[28]孟云凤.艾灸百会治疗神经衰弱(J).针刺研究,1997,(3):208
[29]孙开明,唐在莲.针刺加艾条治疗失眠60例报告(J).职业与健康,2005:21(2):281