Clinical Study Of "Zhou's Acupuncture Method" For The Treatment Of Primary Insomnia Sleep Quality And Daytime Fatigue Status

ObjectiveObserve the effects of Chou’s Tiaoshen acupoints on sleep quality and daytime fatigue of primary insomnia patients.MethodLiterature research:All the published literatures about primary insomnia RCT researches using acupuncture had been searched in the chinese and english databases such as CNKI.WANFANG,VIP,PubMed and Cochrane Library from January 2007 to January 2017.Note Express 3.2 software was used to summarize and analyze the collected data through reading the title and abstract,excluding the obvious not meeted the inclusion criteria.Reading the full text for further screening.Finally.the literatures accorded with the inclusion criteria were classified and summarized,and the datas were extracted by the key words of syndrome differentiation,acupoints.and daytime function or daytime fatigue.2016 edition of Microsoft Excel was used to collect and statistical analysis datas.Clinical research:Randomized,single-blind and parallel control method was taken.According to the ratio of 1:1 and the method of countastic.elimitating the cases which were dropped and excluded,57 patients were divided into two groups.30 cases in treatment group,27 cases in control group.The treatment group used Chou’s Tiaoshen acupoints:GV20,GV 24,EX-HN1,GB13,HT7,PC6,SP6,punctured in SP6（double）,PC6（doubIe）,HT7（double）with 1.5 inch needle until the patients got the feelings of distension.Meanwhile.needle GV20,GV24,EX-HN1and GB13 with 1 inch needle and the method of horizontal needling.Each acupoint treated with the method of mild reinforcing and attenuating manipulation until deqi.The control group was intervened with acupoints irrelevant to primary insomnia treatment:LI14,LI 10,TE4,TE5,GB31,ST32,ST34,without needle manipulation.1-2mm was inserted to skin,the needle and the filling technique was not permitted.Both of groups were acupunctured 30minutes each time,3 times a week for 4 weeks.During the period of treatment,any Chinese and Western medicines were forbidden.The Pittsburgh sleep quality index（PSQI）including the items of sleep quality,sleep latency,sleeping time,sleep efficiency,daytime function.Fatigue Scale（FS-14）including the items of physical fatigue and mental fatigue.Which were evaluated at the time of baseline,treatment after 4 weeks and 8 weeks follow-up.ResultLiterature search result:102 articles met inclusion criteria,including 41 articles about syndrome differentiation and treatment.We analyzed 41 articles and sorted the syndrome differentiation with frequency:the frequency is Heart and spleen deficiency syndrome（41）,heart-Qi and gallbladder-Qi deficiency syndrome（31）and incoordination between heart and kidney syndrome（31）and stagnation of the fire certificate（23）.For the commonly used combination of acupoints,BL15and BL20 for Heart and spleen deficiency syndrome,BL15 and BL19 for heart-Qi and gallbladder-Qi deficiencysyndrome,K13,BL15 and BL23 for incoordination between heart and kidney syndrome.LR3 and LR2 for stagnation of the fire certificate.Ranking the acupoints which were selected,the most commonly used included:HT7（59）,GV20（48）,SP6（47）,LR3（33）,EX-HN1（33）,BL15（32）,PC6（32）and KI6（31）.The Bladder Meridian（151）and Governor Meridian（107）are most commonly chose meridian.29 articles evaluated the daytime function by PSQI scale.2 articles in English evaluated the patients’ early-wake but didn’t evaluate the daytime fatigue.Clinical study results:1.Based on the Pittsburgh Sleep Quality Index（PSQI）evaluation results:Intra group comparison before and after treatment,the results showed that in the treatment group PSQI scores were significantly improved after 4 weeks of treatment and at 8 weeks follow-up(P₄,<0.O1,P_8w<0.01),compared with those of the patients when included.In the control group PSQI scores were significantly improved after 4 weeks of treatment and at 8 weeks follow-up,of which differences were statistically significant（P4W<0.05,P8,<0.05）,compared with those of the patients when included.After 4 weeks of treatment,The average score of PSQI in the treatment group was better than the control group（P<0.01）.At 8 weeks follow-up,The average score of PSQI in the treatment group was better than the control group（P<0.01）.Conducting repeated measurement variance analysis to PSQI scores when included,after 4 weeks of treatment and at 8 weeks follow-up,the results showing that the treatment group was better than the control group.2.Between group comparison of PSQI ingredients,after 4 weeks of treatment,the sleep quality and sleep ef’ficiency of the treatment group are better than the control group（Pvalueof sleep quality=0.027,Pvalueof sleep efficiency=0.025）.At 8 weeks follow-up,the sleep quality and daytime function of the treatment group are better than the control group（Pvalueof sleep quality=0.030,Pvalueof daytime function=0.025）.3.Based on FS-14 assessment result:Intra group comparison before and after treatment,the results showed that.compared with baseline.FS-14 scores were significantly improved both after 4 weeks treatment（P4、’<0.01）and 8 weeks follow-up（P8w<0.01）in the treatment group.While in the control group,the scores didn’t significantly improve before and after treatment（P4w=0.104,P8w=0.366）.The results found that after 4 weeks of treatment,the average scores and thefatigue score are significantly improved of treatment group compared to the control group in the respects of average point,decline of integral and the improvement rate.（P=0.002）.Compared to the baseline,FS-14 treatment group was significantly improvedcompared to the control group in the respects of average point,decline of integral and the improvement rate.（P=0.009）.Based on thescores of FS-14 at baseline,4 weeks after the treatment and follow-up after 8 weeks,repeated measures MNOVA were conducted.The result showed that treatment group significantly improved patients’ daytime fatigue compared to control group.（P=0.009）4.Analysis of physical and mental fatigue in FS-14 showed that,after 4 weeks treatment and follow-up after 8 weeks,treatment group performed better than control group(P_4,physical=0.022,P_{4w mental}=0.017,P_{8w physical}=0.024,P_{8w mental}=0.001),indicating that Tiaoshen acupoints can significantly improve physical and mental fatigue in primary insomnia patients and the effects can last till 8 weeks’ follow-up.ConclusionChou’s Tiaoshen acupuncture is a safe and effective method for the treatment of primary insomnia,can effectively improve the sleep of patients with primary insomnia;Also,it can effectively improve the patient’s daytime fatiguecondition,especially the mental fatigue.The stable and durableeffect was found after 4 weeks Chou’s Tiaoshen acupuncture,even at thefollow-up time after 8 Weeks.Lead by the theory of "regulating the brain God",Chou’s Tiaoshen acupunctureadjust the balance of heart,liver,spleen and kidney,with the simple and practical acupoints,to achieve the balance of yin and Yang,harmony of viscera function,the excellent effect of sleepness.InnovationBy choosing the most common symptom-daytime fatigue as the point.of primary insomnia patients’ physical and mental fatigue,we studied through the daytime performance of primary insomnia patients after Chou’s Tiaoshen acupuncture treatment,discussed the possible mechanism of Chou’s Tiaoshen acupoints treatment in primary insomnia,and lay the foundation for the application of Chou’s Tiaoshen acupoints.