| BackgroundSleep disorder is one of the diseases that can seriously harm people’s life quality,and appropriate intervention for insomnia patients will greatly reduce the morbidity of other diseases,so how to improve the prevention and treatment level of insomnia accompanied anxiety has become an urgent and major medical and social problem.Although traditional Chinese medicine(TCM)and western medicine therapy can improve people’s sleep quality,none of them had evidence-based medicine evidence that can cut off the unity circuits of body and spirit,and realize ’state-target combination’.Narrative therapy has been developed rapidly,and research shows that it can treat the patients both physically and mentally,achieve psychosomatic unity,and improve the response pattern of cognition-emotion.However,there are few efficacy evaluation and mechanism studies of TCM intervention and narrative medical treatment of insomnia with anxiety.Thus,this study aims to clarify the internal mechanism of the brain-gut association of anxiety-induced insomnia and intervention effect of the combination of narrative therapy and liver and spleen method.ObjectivesTo study the clinical characteristics of insomnia with interaction and core syndrome mechanism based on autonomic-brain-gut-inflammatory immune-vascular function association,and the role of liver and spleen method and narrative treatment on truncation interaction pathway,and improve the clinical understanding of body and mind integration,shape and value adjustment of insomnia with anxiety.MethodsFirst,in terms of cross-sectional studies,insomniacs associated with anxiety were selected as the study subjects,those without anxiety as control group.All patients’ demographic and basic data,containing their personality and life habits,were collected.Sleep quality,anxiety,depression,stress were then respectively assessed by using the Pittsburgh Sleep Quality Index(PSQI),Hamilton anxiety scale(HAMA),Hamilton depression scale(HAMD),perceived stress scale(PSS),and then HXD-1 tester was used to detect Heart rate variability.In addition to the inflammatory factors interleukin-6(IL-6),high-sensitivity C-reactive protein(HsCRP)and C-reactive protein(CRP),the brain-gut peptide substance included CCK-8,Orexin-A,β-Ep,VIP,Apelin-17,QQ technique was used to detect the clinical mechanism of this disease.Second,insomnia accompanying anxiety patients in the encephalology clinic of hospital were included.The basic clinical information of TCM was investigated.Through clinical syndrome observation in patients with anxiety and insomnia,the distribution frequency of the main symptoms and accompanying symptom of anxiety insomnia were summarized.In addition to the cluster analysis and factor analysis,Chinese medicine four diagnostic of insomnia combined anxiety was conducted.Finally,by using the method of prospective non-randomized controlled study,the patients of anxiety and insomnia with liver depression and spleen deficiency syndrome were included.The insomnia accompanying anxiety patients were divided into control group and treatment group.The control Group was under harmonizing the liver-spleen method(TCM group),while the treatment group received both narrative therapy and harmonizing the liver-spleen method(TCM+NT group).The primary outcomes were reducing score rate of TCM syndrome,while the secondary outcome included PSQI score,HAMA score,HAMD score,GSRS score.These two groups were treated continuously for 4 weeks.The patients were followed up for 3 months after treatment.During the follow-up,interpolation method was used to deal with missing data caused by interpolation,PSM for confounding factors,and difference test to evaluate the long term effect of narrative therapy and harmonizing the liver-spleen method.Results1.Study of clinical mechanismA total of 559 insomniacs were included in this study,and the proportion of female patients was significantly greater than that of men;the number of mental workers was much more than the physical workers;In terms of the age distribution,it was concentrated between 30 and 60 years;in terms of comorbidity,hypertension and cervical spondylosis were in the majority.However,there was no significant difference among sex,age,occupation distribution,and comorbidity disease in the anxiety and non-anxiety group.In terms of living habits,there were clear differences among daily routine,psychological pressure,staying up too late,sour diet,and spicy food in the anxiety and non-anxiety group(P<0.05,P<0.01).In terms of personality characteristics,the number of anxiety groups was far more than the non-anxiety group in anger,sulking too much,tension,getting nervous when talking to people,desiring to be quiet(P<0.05,P<0.01).The results of PSQI scores showed differences between the anxiety group and non-anxiety group in terms of PSQI total score,sleep quality,sleep time,sleep efficiency,sleep disorders,hypnotic drugs,and daytime dysfunction.In terms of heart rate variability indicators,SDNN、TP、VLF、LF、LF/HF、LF norm of insomnia patients of different anxiety,the difference is statistically significant(P<0.05).With regard to tension and anxiety,emotional stress,brain vitality,brain fatigue,there were statistical differences between the anxiety group and non-anxiety group in brain function.As to brain gut peptide and serum inflammatory factors,compared with the non-anxiety group,the scores of VIP,orexin-a and CCK-8 faces were significantly higher(P<0.05,P<0.01),and there was no difference in IL-6,HsCRP,CRP.In terms of Quality Intima Media Thickness(QIMT)and Quality Arterial Stiffness(QAS),the right QIMT in the anxiety group was significantly larger than that of the non-anxiety group.2.Study on the characteristics of syndromeAfter screening and sorting the 105 items of TCM four diagnosis information of patients with insomnia accompanied anxiety,the results showed that the top three TCM symptoms and signs were thoughtfulness(68.8%),sighing frequently(59.5%),and fatigue(59.5%);the top three specific tongue veins were pale tongue(64.8%),whitish fur(63.9%),and deep pulse(61%).Then this analysis was performed by clustering,and the common syndrome of insomnia accompanied anxiety was liver depression and spleen deficiency syndrome,liver and stomach incompatibility syndrome,cardiovascular fever syndrome,gallbladder Qi deficiency syndrome,and Yang stagnation syndrome.Through the factor analysis,it is summarized and verified that the main syndrome elements of anxiety insomnia are Qi deficiency,Qi stagnation,heat,deficiency of Yang,phlegm turbidity and so on.Among them,Qi stagnation was found throughout.The pathological target were mainly related to the liver and spleen.Then the syndrome elements and disease target were combined,and the common syndrome of insomnia accompanied anxiety was liver and spleen deficiency syndrome(41.8%),liver syndrome(24.9%),Yang stagnation(23.7%),gallbladder deficiency syndrome(16.1%).In total,the core syndrome of insomnia accompanied anxiety is liver and spleen deficiency syndrome.3.Study of clinical efficacy evaluationThe scores of HAMA,Somatic symptoms,psychiatric symptoms,HAMD,TCM syndrome and gastrointestinal symptoms of 2w and 4w control group and treatment group were significantly lower than that of corresponding group(P<0.01).Comparison between groups with full data set showed that the PSQI score,HAMA score,GSRS of TCM+NT group at 2 and 4 weeks,1 and 3months was significantly lower than that of the TCM group(P<0.05,P<0.01);HAMD score of 2 weeks,3 months was significantly lower than that of the TCM group(P<0.05,P<0.01);TCM syndrome score of 2 weeks,1months was significantly lower than that of the TCM group(P<0.05,P<0.01).Comparison between groups with PSM data set are as follows:at 3 month,the PSQI score of TCM+NT group was lower than TCM group(P<0.05);the HAMD score of TCM+NT group at 4 weeks and 3 months was significantly lower than the TCM group(P<0.01,P<0.05);After 1 month treatment,the TCM+NT group was better than TCM group alone in reducing TCM syndrome score;At 1 and 3 months after treatment,the TCM+NT group was superior than TCM group alone in reducing GSRS score(P<0.05,P<0.01).In terms of curative effect,the full data set showed that total effective rate was 94.5 of TCM group and 93.1%of TCM+NT group after 4 weeks of treatment.The PSM data set showed that total effective rate was 95.8%of TCM group and 91.7%of TCM+NT group after 4 weeks of treatment.The conversion rate of TCM+NT group of PSM date was significantly higher than that of the TCM group at 3 months(P<0.05).Conclusions1.This study suggested that the person who was female,young and have mental work in higher intellectual would be more likely to suffer from insomnia.Insomnia who had negative life events and bad personality would show more anxiety symptoms and insomnia worse.Patients with anxiety insomnia have more obvious abnormalities of brain-intestinal peptide,autonomic functional status,and endovascular media thickness than patients with non-anxiety insomnia.2.It has confirmed that the syndrome characteristics of insomnia accompanied anxiety are recognized from the overall,and it is clear that liver Qi and spleen deficiency plays a significant role in the disease.3.Narrative therapy and harmonizing the liver-spleen method exert an explicit therapeutic effect on patients with insomnia accompanied anxiety.In addition,it can further improve physical and mental perception of patients,adjust their cognitive and emotional response mode,truncate off the vicious loop which called circuit road physique and spirit interaction,and achieve the divine effect of unity of body and spirit and relaxing and calming. |
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