| Objective: Based on the evaluation of the clinical effects of acupuncture at Shenmai and Zhaohai on patients with chronic insomnia,it is preliminary to explore whether the efficacy for chronic insomnia is based on Yin Yang Qiao Meridian.To explore the mechanism underlying the acupuncture efficacy,the effects of acupuncture Shenmai and Zhaohai on the expression of c-fos protein in insomnia rats were observed.Methods: Clinical trial: 150 patients with chronic insomnia were randomly divided with 1:1:1:1:1 ratio into control group,Shenmai with Zhaohai group,Zhubin with Shenmai group,Jinmen with Zhaohai group,and Zhubin with Jinmen group.All the four groups were treated with bilateral Pingbu Pingxie therapy,while the control group was treated with shallow needling at pseudo-acupoints.Each subject was treated 3 times a week for a total of 10 treatments.The Insomnia Severity Index(ISI)was used as the main measurement to evaluate the sleep status of the subjects.The secondary measurements included the Pittsburgh Sleep Quality Index(PSQI)and the Fatigue Scale-14(FS-14),Beck Anxiety Inventory(BAI),Beck Depression inventory-I amended(BDI-IA).Animal experiment: Chronic sciatic nerve constriction injury(CCI)was selected as a long-term insomnia rat model.SD rats were randomly divided into sham operation group(n=5)and model group(n=16).Changes in pain threshold at 7d and 15 d after model operation,and changes in sleep and arousal at 8d and 16 d after model operation were observed.Based on the success of model identification,SD rats were randomly divided into model group(n=5),acupuncture group(n =6)and the control group(n=5).The acupuncture points are bilateral Shenmai(B62)and Zhaohai(K6),and acupuncture at 8:00 every day for 20 minutes for 7 days.SD rats were randomly divided into blank group(n=5),model group(n=5),acupuncture group(n=5)and control group(n=5).Brain was perfused 90 minutes after the seventh acupuncture intervention to observe the expression of c-fos protein in central nucleus.Results: Clinical trial: A total of 150 cases were collected in this trial,21 cases dropped out,the dropping rate was 14%,and 129 effective cases were collected.There were no statistically significant differences in gender composition,age,body mass index(BMI),and whether or not using the drugs between the five groups.The baseline scores of ISI,PSQI,FS-14,BAI and BDI-IA scales between the five groups were balanced.After the treatments,the total scores of ISI in Shenmai with Zhaohai Group decreased by 9.24 points,which was significantly different from other groups(P<0.05).Compared with the other groups,the difference was statistically significant(P<0.05).Some of the secondary measures showed significant improvement before and after treatment,but there was no statistically significant difference between the groups.Animal experiment: At 8 days and 16 days after operation,the Wake accumulation of 12 h Light in the model group was significantly higher than that in the sham operation group.The NREM sleep accumulation of 12 h Light was significantly lower than that of the sham operation group.The difference was statistically significant,which proved that the model was successful.On the basis of this model,after 7 days of acupuncture intervention(ie,16 days after operation),the Wake accumulation of 12 h Light in the acupuncture group was significantly lower than that of the control group compared with the model group(P=0.026,P=0.024).The NREM sleep accumulation of 12 h Light during the day was significantly higher than that of the control group compared with the model group(P=0.016,P=0.031).There was no significant difference in NREM sleep accumulation between groups(P=0.902,P=0.602).Immunohisto-chemical results showed that the expression of c-fos protein in the central amygdala(Ce)of CCI-induced rats was significantly increased compared with the blank group.The expressions of c-fos protein in the locus coeruleus(LC),the dorsal raphe nucleus(DRN),the intergeniculate leaflet(IGL),the olivary pretectal nucleus(OPN),and the lateral habenular nucleus(LHb)were significantly increased after intervention in acupuncture group compared with the control group,the model group,and the blank group.Conclusion: 1.Based on the clinical efficacy of different groups and the theory of "meridian passing through,main treatment within reach",it is partly proved that Shenmai and Zhaohai acupoints play a role in treating chronic insomnia based on Yinyang Qiao Meridian which circulation is different from that of bladder meridian and kidney meridian.2.The rat model of long-term insomnia induced by pain was successfully made,and it was preliminarily confirmed that acupuncture on Shenmai and Zhaohai could effectively regulate the sleep of insomnia rats.3.In animal experiments,it was found that acupuncture could affected the neuronal activity of LC?DRN?IGL?OPN and LHb,which may be the key to acupuncture regulation of sleep-wake disorders. |
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