| BackgroundSleep is a natural,regularly recurring condition of rest for the body and mind in human.Insomnia is the most prevalent sleep complaint in clinical practice and affecting 30%-40%of the general adult population and about 15%-25%of children.Several studies report that approximately 10%of adults are disrupted in their daily activities due to chronic insomnia.There is a significant difference in how much sleep each person needs.Insomnia is a state in which the patient’s physical,psychological,and social activities are interfered with by a strong feeling of sleep deficiency upon waking in the morning and it is a symptom,not a name of a disease.Modern medicine has not possessed a complete and clear understanding of the pathogenesis so far,whereas it is commonly accepted that pathological changes occur in the anatomical structure of the sleep-wake cycle.In addition,endocrine regulation is in close relationship with the sleep-wake rhythm,for hormones like melatonin have been confirmed to have a curative effect on insomnia.In a simple way,the pathogenesis manifests either as a weakening of the inhibitory function or as an enhancement of the arousal function.Insomnia has negative impacts on quality of life,mood,cognitive function,and health and increases risk of depression.It can lead to memory problem and irritability.Insomnia can have serious consequence such as increase risk factors(like hyperlipidemia,hypertension)of coronary artery disease and also cardiovascular disease,automobile-related accident,also decline immunity.Treatment of insomnia in modern medicine is based on management of life style and medication.Medicines those prescribed in insomnia have not good effect on insomnia,in other hand after a period of use,they do not have effect anymore on insomnia.Hypnotic drugs tend to be the dominant form of treatment of insomnia,but these come with a number of reported side effects In other words,based on valid scientific texts,nevertheless insomnia is broad wide in all of the world but remained under-treated in modern medicine and does not have acceptable treatment yet.Acupuncture has been studied as an alternative,resulting in a rising need for methodological research towards verifying its efficacy as insomnia treatment.Findings from basic medical research show that acupuncture stimulation causes release of endorphins,serotonin,enkephalins,and y-amino-butyric acid(GABA;a major inhibitory neurotransmitter of the brain),norepinephrine,and dopamine that helped to explain the acupuncture effect on a biomedical and pharmacological basis that was acceptable to the Western medical establishment.According to ancient TCM classic of Nei Jing(Inner Classic),insomnia is a consequence of the vicious cycle of "daytime low-spirit" and "nighttime hyper arousal state." Acupuncture is considered to be beneficial to restore the normal sleep-wake cycle by regulating and restoring the natural flow of Qi.Based on previous research in TCM,through literature review and some preliminary work,confirmed there are some patterns and also some treatment methods in treating of insomnia with acupuncture.It has to be acknowledged that most TCM concepts and therapies have not yet been proven by scientific method.Nevertheless,its evidence is plagued by methodology design limitation.More clinical trials are needed to further study the efficacy of acupuncture for insomnia.Acupoints selection in treating with acupuncture are used in two ways,one is formula acupuncture and the other is individualized acupuncture.Individualized acupuncture means that the practitioner selects and combines points based on individualized syndrome differentiation due to TCM theory.TCM theory,is defined as a diagnostic conclusion of the pathological changes of a disease state based on an individual’s symptoms and signs,including pulse form and tongue appearance.In contrast,formula acupuncture means that the practitioner use a group of points those have therapeutic effect for that problem based on texts,without no particular attention to syndrome differentiation and principles of TCM.In the event that acupuncture is more effective for treatment insomnia if it planned based on distinguish syndrome differentiation for every patient,due to TCM theory.ObjectivesIn this study we recognize and understand that how we can differentiate syndromes for insomnia according to zang-fu based,meridian based and substance based.Then in patient’s treatment we observe point selecting and other techniques to get the best result such as type and size of the needle,deqi sensation,manipulation,depth of needle insertion and so on.Also we use any additional techniques that use in TCM clinic like blood-letting,cupping,TDP lamp,electro acupuncture,etc.So in this study we have this main goal:Observe clinical effectiveness of acupuncture for insomnia and discuss its mechanism under Professor Li Rui’s supervision.Materials and MethodsWe did this study with an observational method according to syndrome differentiation and diagnosing individual disease pattern through four diagnostic methods in Chinese medicine(Observation,Interrogation,Pulse and Tongue)in treatment of insomnia with proficient acupuncturist,tutor Professor Li Rui.The study performed the period from January 2017 to January 2018 at Guo Yi Tang clinic,Beijing university of Chinese medicine,Beijing,China,under Professor Li Rui’s supervision.10 patient with insomnia treated with acupuncture plus electro acupuncture.Firstly,we took history and with four diagnose of TCM,we specify seven patterns of disharmony:both heart and spleen deficiency,blood stasis,kidney and heart disharmony,disharmony of stomach,liver fire,heart fire,empty fire due to yin deficiency.After that do individualized acupuncture for every patient.We used single-use sterilized acupuncture needle,with the size 40*30(40 mm in length and 0.3 mm in diameter),each session was 20-30 minutes,and the patient had two treatment session in a week.Then the point grouping are selected based on teacher experience,and the points be located due to each patient’s anatomy and teacher experience,then Professor needled the patient with suitable angel and depth,In needling,one important subject is getting deqi,in all patients got de qi by Professor Li Rui,also deqi sensation path is important in some points like GB20(in treating insomnia for calm mind it must be toward the head and brain),then in some points we did manipulation as reducing or reinforcing according to syndrome differentiation.In treatment we use some points to calm mind and because the brain and head is house the mind and as our teacher experience we use DU24,DU20,ST8,GB13,and GB20 for calm mind.We needled HT7 and SP6 as main points in insomnia.We use HT5 and KID6 in some cases as our teacher experience.We use Ren meridian points like CV4,CV6,and CV12 with ST25 to regulate and tonify qi.Some other points due to patient situation or based on meridian which involved used as teacher experience.We use electro acupuncture due to main pathogenic factor or on main points as teacher experience,we use electro acupuncture to promote qi circulation,to resolve pathogenic factor,to calm mind and to treat insomnia.Electro acupuncture frequency was set to 1 HTZ,intermittent mode,and intensity was setting due to patient’s tolerance,about 5-10.Electro acupuncture used for 20 minutes.We putted TDP lamp on patient’s abdomen for moxa like effect to tonify qi.At last we do cupping and blood-letting in some cases,we did this process to resolve pathogenic factor or substance involvement,on target area or back shu due to syndrome differentiation.ConclusionIn this study,insomnia is usually mixed pattern,not as a simple syndrome in differentiation.Actually insomnia is a manifestation of a syndrome,so it must be treated firstly and secondly the syndrome must be considered as a root treatment.When a patient comes with insomnia we must approach to this problem in three aspect:substance involvement,meridian involvement and zang-fu involvement.Then we used some points to treat "biao" that here is insomnia.In addition we use some points as main points in insomnia,some other points added to treat the "ben",means treat the cause of insomnia based on syndrome differentiation.Also we use some other points and complementary treatments to resolve pathogenic factors.Due to TCM,whenever we have insomnia,absolutely the shen is irritable and do not settle to its place,so calm mind and shen is one of the important principle of treatment in insomnia.In addition in insomnia usually the heart and kidney is not harmonized,and the spleen is deficient,so most of the point grouping selected for this three subject.One another important subject that not attention to it in western acupuncture is to resolve pathogenic factor and treat substance involvement like stasis and heat in blood.Also in individualized acupuncture some other points selected based on meridian involvement that rarely attention to it in western acupuncture.Another thing that is so important to increase efficacy of treatment is getting deqi in each patient,on every point.We evaluated treatment protocol of 10 patients of insomnia based on diagnostic methods of Chinese medicine.Some patterns was more common,like heart and kidney disharmony and also stasis and heat was common in our patients.GV24(shenting),GV20(baihui),ST8(touwei),GB13(benshen)combination usually select for calm mind and calm shen in insomnia patient.Sometimes we use GB20,too Usually both GV24(shenting)and GV20(baihui)are used in treatment of insomnia,and the three others combine in treatment based on symptoms like digestive system symptoms,any manifestation of wind,and so on.HT7(shenmen)and SP6(sanyinjiao)are main points for treating insomnia.It can be used in any cases of insomnia especially with both heart and spleen deficiency,yin deficiency,heart fire and liver fire and also in blood disease like heat in blood or blood stasis,stomach disharmony,also can use in cases with heart and kidney disharmony.HT5(tongli)and KI6(zhaohai)combination is another point grouping that our teacher use for insomnia,as his experience in some cases with insomnia.This combination can be used for any insomnia patient that has yin deficiency,heart and kidney disharmony.BL62(shenmai)and KID6(zhaohai)is the other combination that our teacher use in insomnia,this combination therapy is used for disharmony between yin qiao and yang qiao,like jet lagging or any recent insomnia and so on.ST25(tianshu),CV4(guanyuan),CV6(qihai),CV12(zhongwan)is a combination for tonify spleen and stomach,tonify and regulate qi in treatment of insomnia.This combination that often use in insomnia patient can regulate qi,harmonize blood,tonify spleen and stomach and nourish kidney.BL15(xinshu)and BL19(danshu)can be use in addition by other necessary point selection,for heart and gallbladder deficiency.Electro acupuncture mainly use on HT7(shenmen)and SP6(sanyinjiao),and HT5(tongli)and KI6(zhaohai),based on "ben" and also the main pathogenic factor in each patient.Cupping and blood-letting on BL17(geshu)and BL40(weizhong)in insomnia patient with heat or stasis in blood usually use to invigorate blood movement by resolve stasis and can drain heat in blood and cool blood.As we see,in our cases after 1-3 session,first respond was starts and totally all patients were satisfied after 3-5 sessions.Even though the most of points are the same in patient of insomnia in this study,the same 2-3 points that were added for every patient based on syndrome differentiation,improve the efficacy of treatment.According to TCM theory,selecting minimum points with maximum effectiveness based on patient situation can cause minimum qi involvement and more concentration of qi to treat the disease.This study recommended that with researches based on TCM theory we can specify true strength of acupuncture and documenting that for developing Chinese acupuncture all of the world. |
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