【作者】 黎光昇；

【导师】 金宏柱；

【作者基本信息】 南京中医药大学 ， 针灸推拿学， 2009， 博士

【摘要】 失眠(insomnia)是以難以入睡和維持睡眠困難爲特徵,並影響睡眠品質的一種最常見的睡眠障礙。失眠者易出現困倦,焦慮、沮喪,社會退縮,興趣缺乏,注意力不集中等症狀。失眠雖然不是危及人類生命的重症;但是已成爲影響人類身心健康、生活品質和工作效率的重要因素。因睡眠品質問題所帶來的醫療費用增加和工作效率下降已成爲許多國家廣泛關注的公共衛生問題。我們通過理論研究認識了西醫學在失眠的流行病學特點、定義、病因和分型、發病機制、診斷和治療等方面的最新研究進展;系統歸納總結了祖國醫學對失眠的病名、病因病機、防治方法的有關論述,指出失眠的主要發病機制是陰陽失調,並且與五臟功能紊亂關係密切,主要表現爲五臟神失守。在導師長期從事健身氣功的研究基礎上,進行了健身氣功·新編五禽戲治療慢性失眠的臨床研究。臨床研究以健身氣功·新編五禽戲結合放鬆功對慢性失眠患者進行干預,將匹茲堡睡眠品質指數(PSQI)作爲綜合反應睡眠品質的指標、將Epworth困倦指數、焦慮自評量表(SAS)、和抑鬱自評量表(SDS)作爲反應患者由失眠引發的困倦、焦慮和抑鬱狀態的指標,將睡眠時間、睡眠品質作爲臨床療效評定依據。與太極拳結合放鬆功、步行結合放鬆功進行比較。結果表明:從PSQI七因數評分以及主要睡眠指標看,五禽戲結合放鬆功和太極拳結合放鬆功對PSQI七因數評分的每一因數計分、PSQI總分、主要睡眠指標均有明顯改善,且前者優於後者。而作爲對照的步行結合放鬆功僅能改善睡眠品質、入睡時間、睡眠效率、睡眠障礙等部分指標,且不具優越性。在睡眠時間療效方面,五禽戲結合放鬆功的有效率爲92.9%,愈顯率爲50%;太極拳結合放鬆功的有效率爲77.8%,愈顯率爲25.9%;步行結合放鬆功的有效率爲52.4%,愈顯率爲14.3%。在睡眠品質療效方面,五禽戲結合放鬆功的有效率爲92.9%,愈顯率爲57.1%;太極拳結合放鬆功的有效率爲85.2%,愈顯率爲37.0%;步行結合放鬆功的有效率爲52.3%,愈顯率爲14.3%。可以看出在睡眠時間和睡眠治療療效評定的方面,五禽戲結合放鬆功的療效最優,有效率、痊癒率均顯著高於太極拳結合放鬆功療法和步行結合放鬆功療法。在日間困倦狀態的改善方面,五禽戲結合放鬆功、太極拳結合放鬆功、步行結合放鬆功對患者的Epworth困倦指數積分均有改善,而五禽戲結合放鬆功的療效更爲明顯。說明五禽戲結合放鬆功鍛煉能有效改善失眠患者的日間困倦狀態。在伴有的焦慮和抑鬱的症狀改善方面,五禽戲結合放鬆功、太極拳結合放鬆功、步行結合放鬆功對患者的焦慮指數(SAS)積分、抑鬱指數(SDS)積分也均有改善,而五禽戲結合放鬆功的療效也更爲明顯。說明五禽戲結合放鬆功鍛煉能有效改善失眠患者伴有的焦慮和抑鬱症狀。我們的研究提示:五禽戲結合放鬆功能有效地延長睡眠時間,提高睡眠品質,提高睡眠效率,促進患者日間功能的恢復,改善失眠患者伴有焦慮、抑鬱等不良精神狀態,達到有效治療失眠的目的。作爲非藥物療法,五禽戲結合放鬆功則具有安全有效、無明顯副作用,且能節約醫療資源,減輕患者經濟負擔的優勢。推測五禽戲防治疾病的作用機理主要是通過調心、調氣、調身來達到舒暢情志,疏經通絡,調整臟腑,調和人體各部氣血陰陽,使人體陰平陽秘,精神乃治。對治療失眠則有寧心安神,協調陰陽,調五臟,安五臟神的良好功效。配合健身氣功中的放鬆功法,可動靜結合,更有效地誘導睡眠。本研究爲健身氣功·新編五禽戲拓寬了防治病種的範圍,並進一步推廣提供科學依據。更多还原

【Abstract】 Insomnia is one of the most common diseases of sleep disorder, with the characters of difficulty falling asleep and keeping asleep, poor sleep quality. The patient often have the symptoms of drowsiness, anxiety, depressed, interest lack, withdrawing in society life, impaired concentration. Insomnia is not the severe disease endangering life, but it has been the important factor that effect people’s physical and mental health, quality of life, work ratio. The sleep quality problem causes the increasing of medical cost and the decreasing of work ratio. This has been a major public health problem.We cognize the epidemiology characteristic, definition, etiological factors and grouping, diagnosis and treatment in stable condition of insomnia by review the newest literature in western medicine. We systematically conclude and summarize the name, symptom, pathogenesis, the control principle of the disease in TCM and indicate the direction of clinical research. We consider the main pathogenesy of insomnia is imbalance of Yin and Yang. Insomnia has a close connection with the disturbance of Five viscera at the same time. While the dysfunction of five viscera which can’t hold their own vitality. Insomnia is the sign which tell the disharmeny of the Yin and Yang rhythm in the day and night and the dysfunction of five organs which can’t hole their own vitality. We carry on the research treating chronic insomnia patient by health qigong·wuqinxi exercise combined with relaxing exercise on the base of my director’s early research.We use Pittsburgh sleep quality index ( PSQI )as synthetic standard in measuring sleep quality, and use Epworth’s weary schedule, Self-anxiety schedule, self-depression schedule reflecting the patient’s drowsiness, anxiety, depressed caused by insomnia. We evaluate the clinic therapeutic effect with sleep time, sleep quality. Comparing with the taijiquan combined with relaxing group and walk combined with relaxing group, the results indicate that: wuqinxi combined with relaxing exercise and taijiquan combined with relaxing exercise all can improve the patient’s PSQI every factor score, total score and main sleep index. And the effect of wuqinxi combined with relaxing exercise is more significant. But walk combined with relaxing exercise as control group can improve only few part of sleep index such as sleep quality, falling sleep time, sleep efficiency, sleep disorder. And the effect is not more significant.In the aspect of effect on sleep time, the effective rate of wuqinxi combined with relaxing exercise is 92.9%, cure and marked effect rate is 50%; the effective rate of taijiquan combined with relaxing exercise is 77.8%, cure and marked effect rate is 25.9%; the effective rate of walk combined with relaxing exercise is 52.4%, cure and marked effect rate is 14.3%. In the aspect of effect on sleep quality, the effective rate of wuqinxi combined with relaxing exercise is 92.9%, cure and marked effect rate is 57.1%; the effective rate of taijiquan combined with relaxing exercise is 85.2%, cure and marked effect rate is 37.0%; the effective rate of walk combined with relaxing exercise is 52.3%, cure and marked effect rate is 14.3%. It directs wuqinxi combined with relaxing exercise has the best effect on improving sleep time and sleep quality. The effective rate, recovery and excellence rate of wuqinxi combined with relaxing exercise significantly surpass taijiquan combined with relaxing exercise and walk combined with relaxing exercise. In the aspect of effect on day drowsiness condition, the three group patients’ Epworth’s weary score are all improved, and the wuqinxi combined with relaxing exercise group is more significant. It directs wuqinxi combined with relaxing exercise is more effective. In the aspect of effect on anxiety and depression condition, the three group patients’ SAS score and SDS score are all improved, and the wuqinxi combined with relaxing exercise group is more significant. It directs wuqinxi combined with relaxing exercise is more effective.Conclusions: wuqinxi combined with relaxing exercise can effectively prolong sleep time, improve sleep quality and efficiency, advance patient’s day function recovery, and improve patient’s anxiety and depression condition. So it will achieve the control goal of insomnia. As a kind of Non-drug therapy, wuqinxi combined with relaxing exercise is safe and effective, non-side-effect, and it can save medical resource, relieve patient’s economical burden. We speculate the mechanism of wuqinxi is that adjusting emotion, dredging the meridians and collaterals, regulating Zangfu, adjusting Qi and blood, Yin and Yang of partes corporis humani, and making Yin and Yang in a relative equilibrium, life activities being normally maintained. Wuqinxi can calm heart and soothe the nerves, harmonize Yin and Yang, regulat five viscera and make five vitality stored, that cure the insomnia essentially. Wuqinyi combined with relaxing exercise that is one of the health Qigong, can effectively induce sleep by dynamic and static combination. This research provides science proof for spreading Wuqinxi.更多还原