【作者】 吕柏欣；

【导师】 庄礼兴；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2009， 博士

【摘要】 研究背景:失眠症为临床上常见病症之一,是一种持续的睡眠质和/或令人不满意的生理障碍,以睡眠时间、深度及消除疲劳作用不足为主症,以成为严重影响人们生活质量的一种病证,仅中国就约有3亿成年人患有失眠和睡眠过多等睡眠障碍,失眠已成为继头痛之后神经科门诊的第二大疾病。随着失眠发病率的日趋增高,它也越来越受到越来越多的学者关注,但目前西医较理想的是涉及教育、行为疗法和药物治疗等的综合治疗。而今年很多学者报道中医针灸对失眠症有较好疗效。目的:按传统疗法针灸在疾病防治过程中的治疗原则,采取辩证选穴方法的应用,进行临床病例随机对照试验的研究,通过对电针“百会”、“印堂”穴对治疗单纯性失眠的临床,与中药辨证口服对照,证明针灸在单纯性失眠防治中的安全性、有效性及可推广性,寻求一种有效的治疗失眠非药物疗法。方法:台湾高雄县123中医诊所于2008年元月至2008年12月期间就诊的单纯性失眠患者。采用简单随机的方法,设立为电针组(治疗组)和中药辨证组(对照组),两组各30例。治疗组采用针刺百会、印堂为主穴,并根据辨证配穴,心脾两虚加脾俞、心俞,阴虚火旺加大陵、太溪,心胆气虚加心俞、胆俞,痰热内扰加丰隆、中脘,肝郁化火加行间、风池。百会、印堂在得气的基础上,加G6805电针仪,疏密波,频率2/100HZ,强度以患者耐受为度,通电20min,留针30分钟.其余各穴位在行针得气后施以平补平泻法,刺激量以中等为宜,TDP照射,留针30分钟。每周针灸治疗5次,1周为一疗程,2个疗程后观察疗效。对照组采用中药辨证口服,心脾两虚服归脾汤,阴虚火旺服酸枣仁汤,心胆气虚服安神定志丸,痰热内扰服温胆汤加黄连、瓜蒌,肝郁化火服龙肝泻胆汤,水煎服,每日1剂,1周为一疗程,2个疗程后观察疗效。分别于治疗前后进行PSQI和WHOQOL—BREF评分,并于治疗后进行疗效评价。将所得数据建立数据库,应用SPSS13.0统计软件进行统计分析。结果:治疗组与对照组治疗前后PSQI各成分积分比较,P＜0.01,P＜0.05,差异有统计学意义;治疗后治疗组与对照组组间PSQI各成分积分比较,P＜0.01,P＜0.05;治疗组和对照组治疗前后PSQI总积分比较,均P＜0.01,差异有统计学意义:治疗后治疗组与对照组组间PSOI总积分比较,P＜0.05,差异有统计学意义;两组治疗后与治疗前比较,WHOQOL—BREF总积分均有明显提高,P＜0.01,差异有统计学意义:治疗后两组WHOQOL—BREF总积分比较,P＜0.05,差异有统计学意义。治疗组和对照组临床疗效经Ridit分析,P＜0.05。结论:1.电针和中药辨证均能降低失眠患者匹兹堡睡眠质量指数量表总积分及各成分积分,缩短入睡时间,增加睡眠时间,提高睡眠效率,改善睡眠障碍及日间功能障碍,提高睡眠质量,减少催眠药物,改善失眠患者症状,且电针组作用优于中药辨证组。2.电针和中药辨证治均能提高失眠患者生存质量,且电针作用优于中药辨证。3.电针和中药辨证治疗失眠均有较好疗效,但电针组作用优于中药辨证组,认为电针和中药辨证均是治疗失眠的有效方法,且电针的作用更优,更值得临床推广运用。更多还原

【Abstract】 Background:Insomnia is a symptom of a sleeping disorder characterized by persistent difficulty falling asleep or staying asleep despite the opportunity. According to the National survey in China,approximately 300 million adults regularly suffer from sleeping disorder,either from insomnia or hypersomnia. Insomnia has become the second most common condition,after headache,seen in the neurology department.As the prevalence of insomnia rises,more attention has been put to focus in its field of research.The first line of treatment involves non-oharmacological strategies,cognitive behaviour therapy and sleep medications.In recent years,reports with regard to taking a Traditional Chinese medical approach have been released.Objective:To carry out a controlled experiment to investigate the curative effect of electro-acupuncturing baihui and yintang in the treatment of insomnia,using oral herbal concoction therapy in the control group.Method:In the period of January 2007 to December 2008,patients from 123 Chinese Medical Clinic in Kaohsiung,Taiwan were selected to participate in the study.They were randomly divided into treatment(electro-acupuncture) and control(herbal concoction) groups,each consisted of 30 subjects.Those in the treatment group underwent acupuncture therapy;the main chosen acupoints were baihui and yintang.According to the Chinese medical syndrome, additional points were added.Deficiency in the heart and spleen,pishu and xinshu were used:yin-deficient with heat,daling and taixi were used; qi-deficient in the heart and gall bladder,xinshu and danshu were used; retention of phlegm and heat,fenglong,and zhongwan were used;stagnation of the liver qi with heat,Xingjian and fengchi were used.After inserting needles into the two main acupoints baihui and yintang, accomplishing the acupuncture sensation,electro-acupuncture therapy was applied using the G6805 machine,tuned at a frequency of 2/100Hz of the mixed sparse-dense wave.The therapy lasted for 20 minutes,and the other needles were retained for 30 minutes.One course of treatment is five continuous days in a week,and a totat of 2 courses were done.The patients in the control group were treated using herbal concoction according to the above described Chinese medical syndromes.Deficiency in the heart and spleen,guipitang concoction was used;yin-deficient with heat, suanzaorentang concoction were used:qi-deficient in the heart and gall bladder,anshendingzhiwan concoction were used:retention of phlegm and heat, wendantang concoction with huanglian and gualou were used;stagnation of the liver qi with heat,longdanxiegantang concoction were used.The patients were prescribed concoction to be taken once a day for a course of 2 weeks.The quality of sleep was assessed in all patients before and after treatment as per the Pittsburgh Sleep Quality Index(PSQI) and WHO Quality of Life-BREF(WHOQOL-BREF).All data were then statistically analyzed using the SPSS13.0 software,and the clinical effect after treatment was determined.Results:1.PSQI score" After treatment,all comoonents of the PSQI score imoroved in both the treatment and control groups(p＜0.01 and p＜0.05,respectively), with the former having a significantly better score than the latter.The cnange in the components of the PSQI score before and after treatment between the groups was statistically different,with the treatment group achieving a higher score than the control group(p＜0.01).The overal] PSQI score in both groups improved after treatment(p＜0.01).The change in the treatment group was significantly better than that of the control group(p＜0.05).2.WHOQOL-BREF:The WHOQOL-BREF score in both groups significantly increased after treatment(p＜0.01).The change in the treatment group. nowever,was significantly higher than the control group(p＜0.05).Conclusions:1.Differentiating the insomniac patients into the Chinese medical syndromes, both therapies treated accordingly resulted in satisfactory clinical 2.effects,as demonstrated by the improved PSQI and WHOQOL-BREF scores.The time to fall asleep was shortened,the duration of sleep was lengthened,quality of sleep was better,which directly improves the daytime quality of life.The study found that the effect of acupuncture was significantly better than taking herbal concoction.3.Both therapies,were able to improve the quality,of sleep,with the treatment group achieving better results than the control group.4.Electro-acupuncture therapy of the baihui and yintang was more effective in treating insomnia than taking herbal concoction.更多还原