Research On Mechanism And Effect Of Insomnia Based On Syndrome Differentiation And Fixed Type

Objective:Doctors of traditional Chinese medicine diagnose and treat patients with methods of traditional Chinese Medicine(TCM).While different syndromes are closely related to different pathomechanism, the methods of clinical treatment must change according to syndromes. Not only occurrence and development of a disease, but also the essence could be revealed by various methods of diagnosis, such as eight-principle pattern identification, visceral syndrome dialectical, syndrome differentiation of meridians and collaterals. As syndrome differentiation reflects the change of pathogenesis, it could be an integrated therapeutic process with the principles of treatment such as regulating yin and yang, strengthening the vital and dispelling the pathogen. Those all reflect the essence of differential diagnosis and treatment and the main characteristics of TCM theory. However, most recent researchers of Chinese Medicine have adopted modern methodologies and technologies. Those researches were based on meterials and focused on just a given point,a appointed process or aspect with a view of microexamination to standardize Chinese Medicine trials. Those trials may have brought about some innovations but whether meet the principle of holism concept of TCM theory is in doubt. As their methods focus on fragments of disease, especially treating patients of same disease with same therapeutic schedule, diagnosis and treatiment just based on first visit and the same therapy in the whole treatment course. According to pathogenesis of liver-fire type insomnia which refers to fire derived the stagnation of liver, the treatment group change therapeutic schedule based on syndrome differentiation of insomnia, while the control group keep the same therapy from the first visit to the end. The aim of the research is to evaluate the clinical effect of the treatment based on different syndrome of insomnia, and change the relative herbs dosage to fit for syndrome differentiation of insomnia. At the same time, we can evaluate the mechanism and effect of Insomnia based on syndrome different-iation and fixed liver-fire type with combination of modified Xiaoyao powder(from Internal Medicine Abstract) add GuizhiGancaoLongguMuli Decoction(from Treatise on Febrile Diseases, GuiLin ancient editi-on).Methods:Internal injury due to seven emotions may cause disturbances of qi movement, impairment of viscera and diseases then occur,for example, mental disroders could cause insomnia. It is general rule that mental disorders can affect the viscera qi movement first and impair the corresponding viscera. Modern science and technology has been updated so fast that the new electronic products and large media information and pressure of competition are easy to make people feel infinite appetency, at the same time huge tension in psychological cause anxiety and panic. Those mental disorders could cause internal injury especially hurt the liver,leading to upward adverse flow of liver qi or liver-fire flaming, then hurts the heart and leading to insomnia of pathogenic fire derived from stagnation of liver. As Chinese medicine and herbs have a very good therapeutic effect on insomnia, meanwhile, pathogenic fire derived from stagnation of liver is common on clinical and some Chinese medicine herbs could help to smooth liver qi, clear pathogenic fire then peace the mind to cure insomnia. Furthermore, traditional Chinese medicine can have much less side effects such as addiction and forbidden phenomenon. Moreover, traditional Chinese medicine can be effctive in regulating liver qi, clearing stagnated liver fire and settling the mind, regaining the physiological back to normal, so this research is necessary.The explanation of insomnia pathogenesis in Ling Shu Jing is the best in ancient times. The disorder of yin and yang is the based mechamism of insomnia. The excess of liver qi and liver fire offend heart lead to insomnia. So in the study we use the combination of modified Xiaoyao powder add GuizhiGancaoLongguMuli Decoction to treat insomnia. Modified Xiaoyao powder can clear and soothe liver, while GuizhiGancaoLongguMuli Decoction can settle mind in order to balance yin and yang.This research included 80 patients,who were diagnosed as Liver-fire type insomnia from Fuxing hospital in Taiwan from July 2014 to June 2015, had been randomly divided into two groups, the treatment group and the control group. Each group were 40 cases and treated with combination of modified Xiaoyao powder add GuizhiGancaoLongguMuli Decoction. The relative herbs dosage of the decoction is changed to fit for syndrome differentiation of insomnia in the treatment group. And the amount is in line accordance with the percentage of ancient prescriptions and based on the regular rules, both 10 grams each time and three times a day. Treatment time is 6 weeks and observe time is before and after treatment. The two group used the same prescpiption only on the first visit. Then in the treatment group the prescpiption could be gradually added or subtracted ingredients as syndrome of insomnia varies during the treatment progress. While in control group the patients were still treated with the fixed prescpiption during the whole treatment course, that is the difference between the two groups.,,After the treatment we compared and analysed the patients by evaluating the therapeutic effect according to the changs of Pittsburgh Sleep Quality Index(PSQI) scores and TCM symptoms.Results:1. After treatment, the overall effective rate of PSQI scores was 95% in treatment group, the rate was 60% in control group. In treatment group,9 cases were cured,14 cases were gotten significant effect,15 cases were in effect, and 2 cases were ineffective. While in control group,4 cases were cured,11 cases were gotten significant effect,9 cases were in effect, and 16 cases were ineffective. The difference of the PSQI scores between the two groups had statistical significance.2. After treatment, the overall effective rate of TCM symptoms scores was 97.5% in treatment group, the rate was 77.5% in control group. In treatment group,8 cases were cured,24 cases were gotten significant effect,7 cases were in effect, and 1 cases were ineffective. While in control group,5 cases were cured,12 cases were gotten significant effect,14 cases were in effect, and 9 cases were ineffective. There was significant difference comparing with TCM symptoms and the difference of symptoms between the two groups had statistical significance.3.Combining PSQI scores with TCM symptoms of liver-fire type insomnia patients, the better curative effect is able to obtain, and the overall effective rate in treatment group is much higher than in control group.Conclutions:1. The therapeutic effect based on main sleep quality:treatment group is better than control group in the subjective sleep quality, time to falling asleep, sleep time, sleep efficiency, energy during daytime and total curative effects, and the difference between the two groups had statistical significance.2. The therapeutic effect based on difficulty in falling asleep:treatment group is better than control group in the festless sleep, early awakening, dreaminess and total PSQI scores, and the difference between the two groups had statistical significance.3. The therapeutic effect based on TCM syndrome:treatment group is better than control group in the symptomsdifficulty in falling asleep, festless sleep, early awakening, chest stuffy, hypochondriac pain, thirst with desire for drinks, tinnitus with red eyes, mouth dry with bitter taste, poor appetite and changes of tongue-color, and the difference between the two groups had statistical significance.4. Combination of modified Xiaoyao powder add GuizhiGancaoLongguMuli Decoction is quite effective in the treatment of insomnia with syndrome of pathogenic fire derived from stagnation of liver.5. The results of this research might suggest that the scientific research of TCM should be guided with the basic priciples or laws of theroy, the effect may be better. Otherwise, the research may lose the essence of TCM, the development and improvement of TCM research could be limited in the long run.Based on the related literature and the appropriate medical formula sifted in advance,there had no studies on treating liver-fire type insomnia with combination of modified Xiaoyao powder add GuizhiGancaoLongguMuli Decoction. So this research has focused on pathogenic fire derived from stagnation of liver in treating insomnia as to provide additional evidence and direction for further insomnia clinical application.