| Purpose:The purpose of the study is to do the research on the central nervous mechanism by single acupoint and acupoints compatibility treatment of primary insomnia by the methods of AIS scale,ET,PET imaging methods from the perspective of noninvasive central nervous detection technology on primary insomnia and insomnia rats model to demonstrate that the mechanism of single acupoint and acupoints compatibility treatment of insomnia is to improve pathological characteristics of sleep and the hypothesis of general symptoms on target organs by activating related brain regions of sleep-wake,releasing or inhibiting central neurotransmitter in the brain,so as to provide basis for compatibility theory and acupoint selection in the treatment of primary insomnia clinically.Method:1.In the test,64 patients with primary insomnia were randomly divided into 32 cases of single acupoint group and 32 cases of acupoints compatibility group.SD male rats,weight 200 g ~ 250 g,were used in animal experiment,which were randomly divided into normal group,model group,Baihui(GV 20)group,Shenmen(HT7)group,Sanyinjiao(sp6)group and Three-Acupoints-Together group.PCPA was used to make insomnia model.2.Observe the clinical effects on acupuncture of Shenmen and compatibility of god,world and person and the method of calming the nerve by acupuncture of Baihui,Shenmen,Sanyinjiao acupoints from the changes 9 aspects of sober-sleep time,interrupted sleep and wake-up at night,early wake up,total sleep time,overall evaluation of sleep quality,whether sleep disorders affect mood during the day,whether the body function is affected in the day,whether there is drowsiness during the day,and the total score through AIS scale.3.Observe the effect of single acupoint of Shenmen and acupoints compatibility on the central neurotransmitter by the ET detection of expression level of 5-HT,DA,GABA,NE,Ach,and Glu of central neurotransmitter.4.Observe the effect of single acupoint of Shenmen and acupoints compatibility on brain activation and central energy metabolism by PET imaging.Result:1.In single acupoint group,compare with the score of 8 factors in AIS and total score in the sleep time,waking up at night,early awake during the day,total sleep time,total sleep quality,the mood,body function and the degree of drowsing in the day and total score before treatment and after treatment,there was significant difference after the treatment(P <0.01).2.There were no differences on both the score of 8 factors and total scores after the treatment in single acupoint group and follow-up period(P > 0.05).3.In compatibility group,compare with the score of 8 factors and the total score before and after the treatment,there was significant difference before and after the treatment(P <0.01).4.There were no significant differences on both the score of 8 factors and total scores after the treatment in compatibility group and follow-up period(P > 0.05).5.8 factors score in AIS and total score of patients in single acupoint group and acupoints compatibility group showed significant difference(P < 0.01).6.In follow-up period,each factor score in AIS and total score of patients in single acupoint group and acupoints compatibility group showed difference in terms of falling asleep time,wake-up frequency at night,total sleep time,total sleep quality,improvement of emotional state and body function(P < 0.05,P< 0.01),while there was no significant difference in the curative effect of single acupoint group and acupoints compatibility group on aspects of adjustment of early awakening,and degree of drowsing in the day(P > 0.05).7.There are 64 cases with clinical curative effect,including 32 cases of single acupoint group with 1 healed case,6 marked effectual cases,16 effectual cases and 9 non-effectual cases with 71.86% of total effective rate and 32 cases of compatibility group with 4 healed cases,10 marked effectual cases,16 effectual cases and 2 non-effectual cases with 93.75% of total effective rate.There was significant difference of effective rate of 2 groups by the detection of ?2.(?2 =5.379,P = 0.043 < 0.05).8.In single acupoint group,there was a significant difference in terms of 6 neurotransmitter on GABA,Glu,NE,DA before and after the treatment by ET test(P < 0.05).Single acupoint of Shenmen increased the GABA,Glu and NE,and decreased DA.There was no significant difference before and after therapy in terms of neurotransmitters such as 5-HT,Ach and so on(P > 0.05).9.In acupoints compatibility group,there was a significant difference in terms of 6 neurotransmitter on GABA,Glu,DA before and after the treatment by ET test(P < 0.05,P < 0.01),which showed that acupuncture and acupoints compatibility increased the GABA and Glu and decreased DA.There was no significant difference before and after therapy in terms of neurotransmitters such as 5-HT,Ach,NE and so on(P > 0.05).10.After the treatment,the neurotransmitter in ET records of the patients in single acupoint group and compatibility group showed that only 5-HT has difference(P < 0.05),suggesting that there were different degree of adjustment of 5-HT content in both groups and there were no significant difference in terms of the content GABA,Glu,Ach,NE,DA after treatment(P > 0.05).11.Compared with normal group,the brain regions with increased glucose metabolism in model group are: anterior cingulate cortex,hypothalamus,basal ganglia,eventually grain bed nucleus,the caudate putamen,the prefrontal cortex,thalamus,cingulate,corpus callosum,dome,hippocampus,hypothalamus,preoptic area,the hypothalamus nodule area,central cortex,the prefrontal cortex and medulla oblongata,sensory cortex,motor cortex,septal area,pons,pressure is built after the cortex and striatum.The brain regions with decreased glucose metabolism are: the olfactory cortex,lateral frontal edge before the orbitofrontal cortex,the prefrontal cortex,the cortex,thalamus,ventral frontal orbitofrontal cortex,corpus callosum,the cerebellum anterior lobe,cerebellum posterior lobe and the cingulate cortex,lateral prefrontal cortex,the prefrontal cortex and medulla oblongata,olfactory cortex,orbitofrontal cortex,pons,front edge of the cortex is built,the ventral prefrontal cortex,visual cortex.12.Compared with the model group,the brain regions with increased glucose metabolism in Shenmen acupoint group are: agranular insular corex,smelling the former nuclear particles island,the lower edge of the entorhinal cortex,cortex,the visual cortex,the olfactory bulb,the prefrontal cortex,the ventral subiculum,thalamus,orbitofrontal cortex,anterior commissure,corpus callosum,cortex,lateral prefrontal cortex,hippocampus,island,central prefrontal cortex and medulla oblongata,the motor cortex,septal area,frontal orbitofrontal cortex,piriform cortex,ventrolateral prefrontal;The brain regions with decreased glucose metabolism are: the olfactory bulb,the cerebellum posterior lobe of the parietal lobe cortex,sensory cortex,motor cortex,and visual cortex.13.Compared with the model group,the brain regions with increased glucose metabolism in Baihui acupoint group are: brain regions for the subiculum,thalamus,cerebellum anterior lobe,cerebellum posterior lobe,lateral dorsal thalamus nucleus group,in the dorsal thalamus,medulla oblongata and hypothalamus,the midbrain,pons,hill covered,joint pressure after cortex,temporal cortex,visual cortex;The brain regions with decreased glucose metabolism are: the cingulate cortex,the olfactory bulb,the prefrontal cortex,thalamus,corpus callosum,cingulate gyrus,middle prefrontal cortex and medulla oblongata,joint motor cortex,parietal cortex,pons,sensory cortex,and the visual cortex.14.Compared with the model group,the brain regions with increased glucose metabolism in Sanyinjiao acupoint group are: the subiculum,corpus callosum,the hippocampus,the visual cortex;The brain regions with decreased glucose metabolism are: the cerebellum posterior lobe,thalamus,hypothalamus,nodules,medulla oblongata,piriform cortex,pons,sensory cortex,and the visual cortex.15.Compared with the model group,the brain regions with increased glucose metabolism in Three-Acupoints-Together group are: the cingulate cortex,basal ganglia,the amygdala,grain bed nucleus,the prefrontal cortex,striatum,olfactory cortex,black plasmids,subiculum,thalamus,corpus callosum,the cerebellum posterior lobe,and grain,dorsal thalamus abdomen after the lateral nuclear group,the hippocampus umbrella cortex,hippocampus,island,central prefrontal cortex,the area before the lid of the midbrain,motor cortex and the nucleus area,joint the parietal cortex,pressure,sensory cortex and striatum after cortex,temporal association cortex,visual cortex;The brain regions with decreased glucose metabolism are: the cerebellum anterior lobe,thalamus,the cerebellum,medulla oblongata,midbrain of midbrain,covered pons.16.Compared with the Shenmen acupoint group,the brain regions with increased glucose metabolism in Three-Acupoints-Together group are the anterior cingulate cortex,basal ganglia,the amygdala,eventually grain bed nucleus,caudate putamen,rein,the prefrontal cortex,substantia nigra,thalamus,corpus callosum,cingulate,commissure,dorsal thalamus abdomen after the lateral nuclear group,umbrella,dorsal thalamus,the medial nuclear group of hippocampus,internal capsule,the prefrontal cortex,the nucleus area,central joint parietal cortex,pressure after cortex,sensory cortex and striatum and visual cortex;The brain regions with decreased glucose metabolism are: agranular insular cortex,smelling the former nuclear particles island,frontal orbitofrontal cortex,the prefrontal cortex,thalamus,insula cortex and medulla oblongata,motor cortex,the nucleus layers,piriform cortex,covered pons.17.Compared with Baihui acupoint group,the brain regions with increased glucose metabolism in Three-Acupoints-Together group are: subiculum,thalamus,the cerebellum anterior lobe,cerebellum pompoms lobule,hippocampus,medulla oblongata and hypothalamus,the midbrain superior colliculus,the midbrain tegmentum,motor cortex,the olfactory cortex,pons,pressure after cortex,visual cortex is built;The brain regions with decreased glucose metabolism are: the anterior cingulate cortex,basal ganglia,the amygdala,caudate putamen,habenula nucleus,the prefrontal cortex,substantia nigra,subiculum,thalamus,commissure grain,corpus callosum,umbrella,hippocampus,hypothalamus,hippocampus nodule area,internal capsule,island cortex,motor cortex,nuclear,sensory cortex,visual cortex layer joint,parietal cortex and striatum.18.Compared with Sanyinjiao acupoint group,the brain regions with increased glucose metabolism in Three-Acupoints-Together group are: the cingulate cortex,no particles island cortex and the amygdala,the prefrontal cortex,eventually grain bed nuclear,corpus callosum,the cerebellum posterior lobe,cingulate,commissure grain,hippocampal umbrella,island central lobe cortex,lateral prefrontal cortex,the prefrontal cortex;The brain regions with decreased glucose metabolism are: the thalamus,the cerebellum anterior lobe,cerebellum posterior lobe,medulla oblongata and hypothalamus,pons,and the visual cortex.Conclusion:1.Both therapies of single acupoint and acupoints compatibility can effectively treat insomnia.2.The treatment of single acupoint and acupoints compatibility of insomnia can effectively improve clinical insomnia symptoms from different aspects.The curative effect of compatibility group is superior to the single acupoint group with more improving clinical symptoms of insomnia.3.It is showed from ET that both single acupoint and acupoints compatibility can significantly improve the expression of GABA,Glu levels,and reduce the expression levels of DA of patients with insomnia,but there was no statistical difference on the 5 – HT and Ach,and there were no statistical differences among the comparison of the rest neurotransmitters except 5-HT between the two groups.Therefore,the mechanism that curative effect in compatibility group is superior to the single cavity group may be done by adjusting the 5-HT,but further mechanism needs further study.4.PET results showed that single acupoint and acupoints compatibility can activate related brain activity associated with sleep – awake in different degrees,but the stimulations on brain regions has differences,which related to the acupoints location and different compatibility.The farther the distance from the central nervous system,the less activation areas of the brain.Acupoints compatibility with multiple acupoints may stimulate more brain regions than that of single acupoint treatment.In the study,the stimulated brain regions by single acupoint included brain regions such as thalamus GABA and Galanin,medulla oblongata solitary nucleus neurons and serotonin neurons.The stimulated brain regions by acupoints compatibility included the midbrain black plastid dopaminergic neurons,the amygdala can nitric oxide neurons,and striatum dopaminergic neurons besides the regions of single acupoint stimulation.The results were basically in accord with the testing results of ET,which also proved that the mechanism of curative effect of acupuncture compatibility group is superior to that of the single acupoint group.5.The mechanism of single acupoint and acupoints compatibility treatment of insomnia is to improve pathological characteristics of sleep and the hypothesis of general symptoms on target organs by activating related brain regions of sleep-wake,releasing or inhibiting central neurotransmitter in the brain. |
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