浅针联合耳穴压豆治疗气郁质原发性失眠的疗效观察
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摘要
目的:探讨浅针联合耳穴压豆治疗气郁质原发性失眠的临床疗效。方法:气郁质原发性失眠患者60例,随机分为对照组和治疗组各30例。对照组给予阿普唑仑片口服,治疗组给予浅针联合耳穴压豆治疗,均每日治疗1次,连续治疗10d为1个疗程,共治疗3个疗程。分别于治疗前、治疗后、治疗后1个月随访记录匹兹堡睡眠质量指数量表(PSQI)评分、气郁质评分、抑郁自评量表(SDS)评分,并观察两组临床疗效。结果:治疗结束后,治疗组的总有效率为86.7%(26/30),对照组总有效率为96.7%(29/30),差异无统计学意义(P>0.05);但随访期治疗组总有效率(83.3%,25/30)明显高于对照组(53.3%,16/30),治疗组优于对照组(P<0.05)。两组治疗后PSQI评分、SDS评分均较治疗前降低(P<0.05),且治疗组在随访期PSQI评分、SDS评分改善优于对照组(P<0.05)。治疗组气郁质评分较治疗前明显下降(P<0.05),对照组无明显改变(P>0.05),两组治疗后比较差异有统计学意义(P<0.05)。结论:浅针联合耳穴压豆显著改善气郁质原发性失眠患者睡眠质量、抑郁症状及病理体质,且远期疗效稳定持久。
Objective To investigate the clinical effect of shallow acupuncture combined with ear-acupoint pellet-pressing in the treatment of primary insomnia in patients with qi-stagnation constitution.Methods A total of 60 primary insomnia outpatients with qi-stagnation constitution were randomly divided into treatment group and control group,with 30 patients in each group.The patients in the control group were given oral Alprazolam tablets once a day,and those in the treatment group given shallow acupuncture of Yintang(EX-HN3),Shangen(inferior to EX-HN3),Anmian(EX-HN16)and bilateral Xingjian(LR2)and bilateral Taichong(LR3),once a day,and combined with pellet-pressing of ear acupoints"Shenmen""Sympathy""Subcortex""Heart"and"Liver"once every other day.Each course of treatment was 10 consecutive days,and both groups were treated for three courses.The sleep quality was assessed using Pittsburgh Sleep Quality Index(PSQI),the emotional status assessed using Self-rating Depression Scale(SDS),and the qi-stagnation state evaluated according to"the Criteria for Classification and Judgement of Constitution of Traditional Chinese Medicine(2009)".The therapeutic effect was evaluated according to"the Criteria for Diagnosis and Evaluation of Therapeutic Effect of Diseases of Traditional Chinese Medicine".Results Of the two 30 cases in the control and treatment groups,2(6.7%)and 6(20.0%)were cured,6(20.0%)and 14(46.7%)experienced marked improvement in their symptoms,21(70.0%)and 6(20.0%)were effective,and 1(3.3%)and 4(13.3%)ineffective,with the effective rate being 86.7%and96.7%,respectively.No significant difference was found between the two groups in the short-term effect(P>0.05).One month's follow-up showed that,of the two 30 cases in the control and treatment groups,2(6.7%)and 5(16.7%)were cured,4(13.3%)and 14(46.6%)experienced marked improvement,10(33.3%)and 6(20.0%)were effective,and 14(46.7%)and 5(16.7%)ineffective,with the effective rate being 53.3%and 83.3%,respectively.The long-term therapeutic effect of the treatment group was significantly superior to that of the control group(P<0.05).After the treatment,both PSQI and SDS scores in the two groups,and qi-stagnation score in the treatment group showed a significant reduction in comparison with their own pretreatment(P<0.05),and one-month's follow-up(not the short-term outcome)displayed that the PSQI,SDS and qi-stagnation scores of the treatment group were significantly lower than those of the control group(P<0.05).Conclusion Shallow acupuncture combined with ear-acupoint pellet-pressing can significantly improve sleep quality,depression symptoms,and pathological constitution in primary insomnia patients with qi-stagnation constitution,possessing a stable long-term clinical effect.
Objective To investigate the clinical effect of shallow acupuncture combined with ear-acupoint pellet-pressing in the treatment of primary insomnia in patients with qi-stagnation constitution.Methods A total of 60 primary insomnia outpatients with qi-stagnation constitution were randomly divided into treatment group and control group,with 30 patients in each group.The patients in the control group were given oral Alprazolam tablets once a day,and those in the treatment group given shallow acupuncture of Yintang(EX-HN3),Shangen(inferior to EX-HN3),Anmian(EX-HN16)and bilateral Xingjian(LR2)and bilateral Taichong(LR3),once a day,and combined with pellet-pressing of ear acupoints"Shenmen""Sympathy""Subcortex""Heart"and"Liver"once every other day.Each course of treatment was 10 consecutive days,and both groups were treated for three courses.The sleep quality was assessed using Pittsburgh Sleep Quality Index(PSQI),the emotional status assessed using Self-rating Depression Scale(SDS),and the qi-stagnation state evaluated according to"the Criteria for Classification and Judgement of Constitution of Traditional Chinese Medicine(2009)".The therapeutic effect was evaluated according to"the Criteria for Diagnosis and Evaluation of Therapeutic Effect of Diseases of Traditional Chinese Medicine".Results Of the two 30 cases in the control and treatment groups,2(6.7%)and 6(20.0%)were cured,6(20.0%)and 14(46.7%)experienced marked improvement in their symptoms,21(70.0%)and 6(20.0%)were effective,and 1(3.3%)and 4(13.3%)ineffective,with the effective rate being 86.7%and96.7%,respectively.No significant difference was found between the two groups in the short-term effect(P>0.05).One month's follow-up showed that,of the two 30 cases in the control and treatment groups,2(6.7%)and 5(16.7%)were cured,4(13.3%)and 14(46.6%)experienced marked improvement,10(33.3%)and 6(20.0%)were effective,and 14(46.7%)and 5(16.7%)ineffective,with the effective rate being 53.3%and 83.3%,respectively.The long-term therapeutic effect of the treatment group was significantly superior to that of the control group(P<0.05).After the treatment,both PSQI and SDS scores in the two groups,and qi-stagnation score in the treatment group showed a significant reduction in comparison with their own pretreatment(P<0.05),and one-month's follow-up(not the short-term outcome)displayed that the PSQI,SDS and qi-stagnation scores of the treatment group were significantly lower than those of the control group(P<0.05).Conclusion Shallow acupuncture combined with ear-acupoint pellet-pressing can significantly improve sleep quality,depression symptoms,and pathological constitution in primary insomnia patients with qi-stagnation constitution,possessing a stable long-term clinical effect.
引文
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[3]郑美凤,何芙蓉,林煜芬,等.浅针山根穴治疗原发性失眠的疗效观察及其对血清褪黑素的影响[J].浙江中医药大学学报,2014,38(7):902-905.
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[5]胡卫东,陈更业,鞠光亚.耳穴贴压治疗失眠患者睡眠结构的分析与疗效观察[J].宁夏医学杂志,2003,25(11):650-652.
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[12]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国医药科技出版社,1993:186-187.
[13]王琦.9种基本中医体质类型的分类及其诊断表述依据[J].北京中医药大学学报,2005,28(4):1-8.
[14]苏凤哲,卢世秀.路志正教授从五脏论治不寐经验[J].世界中西医结合杂志,2010,5(1):1-3.
[15]龚德贵,黄国芳.浅针在治疗失眠中的特殊作用[J].福建中医药,2012,43(2):50-52.
[16]郑美凤,郑国尧,何芙蓉,等.浅针山根穴治疗原发性失眠静息态功能磁共振研究[J].福建中医药大学学报,2014,24(4):5-9.
[17]魏杰.耳穴压豆治疗顽固性失眠的疗效观察[J].中国社区医师(医学专业),2012,14(2):252.
[18]FALLGATTER A J,NEUHAUSER B,HERRMANN M J,et al.Far field potentials from the brain stem after transcutaneous vagus nerve stimulation[J].J Neural Transm(Vienna),2003,110(12):1437-1443.
[19]FALLGATTER A J,EHLIS A C,RINGEL T M,et al.Age effect on far field potentials from the brain stem after transcutaneous vagus nerve stimulation[J].Int J Psychophysiol,2005,56(1):37-43.
[20]王贵玲.耳穴贴压治疗失眠症临床观察[J].上海针灸杂志,2012,31(10):725-726.
[2]赵敬军,李少源,焦玥,等.耳针治疗失眠的研究现状[J].针灸临床杂志,2014,30(9):82-85.
[3]郑美凤,何芙蓉,林煜芬,等.浅针山根穴治疗原发性失眠的疗效观察及其对血清褪黑素的影响[J].浙江中医药大学学报,2014,38(7):902-905.
[4]项燕.失眠的病机及针灸临床疗效分析[C]//中国针灸学会.2011中国针灸学会年会论文集(摘要).2011:2842-2850.
[5]胡卫东,陈更业,鞠光亚.耳穴贴压治疗失眠患者睡眠结构的分析与疗效观察[J].宁夏医学杂志,2003,25(11):650-652.
[6]黄清苑,罗海龙,李晓芹,等.失眠患者172例中医体质调查[J].新中医,2015,47(8):30-32.
[7]陈晓霞.失眠的体质与证型的相关性研究[D].福州:福建中医药大学,2012.
[8]中华医学会精神科分会.中国精神障碍分类与诊断标准(CC-MD-3B-R)[S].济南:山东科学技术出版社,2001:118-119.
[9]中华中医药学会.中医体质分类与判定(ZYYXH/T157-2009)[J].世界中西医结合杂志,2009,4(4):303-304.
[10]黄之光.黄廷翼浅针术[M].福州:福建科学技术出版社,1991:3.
[11]石芳.浅针治疗阴虚火旺型失眠的临床疗效观察[D].福州:福建中医药大学,2014.
[12]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国医药科技出版社,1993:186-187.
[13]王琦.9种基本中医体质类型的分类及其诊断表述依据[J].北京中医药大学学报,2005,28(4):1-8.
[14]苏凤哲,卢世秀.路志正教授从五脏论治不寐经验[J].世界中西医结合杂志,2010,5(1):1-3.
[15]龚德贵,黄国芳.浅针在治疗失眠中的特殊作用[J].福建中医药,2012,43(2):50-52.
[16]郑美凤,郑国尧,何芙蓉,等.浅针山根穴治疗原发性失眠静息态功能磁共振研究[J].福建中医药大学学报,2014,24(4):5-9.
[17]魏杰.耳穴压豆治疗顽固性失眠的疗效观察[J].中国社区医师(医学专业),2012,14(2):252.
[18]FALLGATTER A J,NEUHAUSER B,HERRMANN M J,et al.Far field potentials from the brain stem after transcutaneous vagus nerve stimulation[J].J Neural Transm(Vienna),2003,110(12):1437-1443.
[19]FALLGATTER A J,EHLIS A C,RINGEL T M,et al.Age effect on far field potentials from the brain stem after transcutaneous vagus nerve stimulation[J].Int J Psychophysiol,2005,56(1):37-43.
[20]王贵玲.耳穴贴压治疗失眠症临床观察[J].上海针灸杂志,2012,31(10):725-726.