| ObjectiveStudy the distribution of TCM syndrome types and characteristics of insomnia patients associated with liver with clinical cross-sectional epidemiological investigation.A randomized controlled clinical trial was carried out to verify the effectiveness of the acupuncture method “Shu ci” in Neijing for insomnia patients with "liver-depression and spleen-deficiency".Finally,explore therapeutic mechanism of acupuncture in treating insomnia due to liver depression and spleen deficiency with the functional magnetic resonance imaging(fmri),so as to provide clinical and experimental basis for acupuncture in treating insomnia.MethodsThis study consists of three parts:Part ? epidemiological investigation: A cross-sectional epidemiological investigation was conducted among 247 insomnia patients associated with liver,including the collection and analysis of patient personal information,Pittsburgh sleep Quality Index(PSQI)and TCM syndrome diagnosis.Part ? a randomized controlled clinical research: Take "liver-depression and spleendeficiency" type as the research object,with is the highest incidence of TCM syndrome types in the epidemiological investigation of insomnia.76 insomnia patients with "liverdepression and spleen-deficiency" type were randomly divided into acupuncture group(38cases)and control group(38cases),treated with “Shu ci” acupuncture method(double side liver shu,lr 3,inter-row,lienal yu,too white,)and sham acupuncture method respectively for 3 weeks,3 times a week.PSQI scale,BDI-?(Beck Depression Inventory-?),SAS(Self-Rating Anxiety Scale)and TCM syndrome diagnosis scale were applied before and after treatment.Part ? functional magnetic resonance imaging(f MRI)study: 12 insomnia patients with "liver-depression and spleen-deficiency" type were randomly divided into acupuncture group(6 cases)and control group(6 cases),treated with “Shu ci” acupuncture method and sham acupuncture method respectively for 3 weeks,3 times a week.Resting state f MRI study were used to detect ALFF(Amplitude of Low Frequency Fluctuations),f ALFF(fractional Amplitude of Low Frequency Fluctuations),VMHC(Voxel-Mirrored Homotopic Connectivity)and Re Ho(Regional Homogeneity)before and after treatment.ResultsResults of epidemiological investigation: 1.Among the insomnia patients associated with liver,liver depression and spleen deficiency TCM type(90/36.5%)were the most,followed by liver qi stagnation and heat type(45/17.8%)and liver and kidney Yin deficiency type(37/15%).2.Among insomnia patients associated with liver,young patients account for the largest proportion(149/60.3%),followed by middle-aged and elderly patients.Female patients(164/66.4%)were more than male patients(83/33.6%).There was no statistical difference in the degree of insomnia among patients of different ages and genders.3.In insomnia patients associated with liver,from more to less,the order of insomnia symptoms is: early awakening,difficulty in falling asleep,urination at night,fear of cold,dreaminess and heat.Results of epidemiological investigation of clinical research: 1.The PSQI scores of acupuncture group and sham acupuncture group after treatment were significantly lower than those before treatment(P<0.05),and the PSQI score of acupuncture group after treatment was significantly lower than that of sham acupuncture group(P<0.05).2.The SAS scores of the two groups were significantly lower than those before treatment(P<0.05),and the score of the acupuncture group was significantly lower than that of the sham acupuncture group(P<0.05).3.The BDI-? scores of two groups after treatment were significantly lower than before treatment(P<0.05),but the scores had no significant difference between two groups.4.The scores of TCM syndromes in the two groups after treatment were significantly lower than those before treatment(P<0.05),and the scores of TCM syndromes in the acupuncture group was significantly lower than that in the sham acupuncture group(P<0.05).5.The overall effective rate of acupuncture group was 84%,and that of the sham acupuncture group was 56%.The therapeutic effect of acupuncture group was significantly better than that of the sham acupuncture group(P<0.05).Results of rs-f MRI(resting state functional magnetic resonance imaging): 1.After treatment,the brain areas with significantly enhanced Re Ho value in the acupuncture group were: right orbital frontal middle gyrus,right inferior temporal gyrus,left middle temporal gyrus,right fusiform gyrus,right middle frontal gyrus,right hippocampus,and left middle frontal gyrus in order from high to low.Compared with the sham acupuncture group,the brain areas with significantly enhanced Re Ho value in the acupuncture group were: left parietal inferior angular gyrus,bilateral thalamus,left precuneus and right lingual gyrus in order from high to low.2.After treatment,the brain regions with the most significant ALFF/f ALFF enhancement in acupuncture group were left thalamus,left precuneus,right cuneus and left occipital middle gyrus,followed by left parietal marginal angular gyrus,left central sulcus,left anterior cingulate gyrus,paracentric cingulate gyrus,right angular gyrus and left middle temporal gyrus.Compared with the sham acupuncture group,the brain areas with the most significant ALFF/f ALFF enhancement after acupuncture were left anterior cingulate and paracentral gyrus,left superior marginal gyrus and left superior occipital gyrus,followed by right superior superior frontal gyrus,right medial frontal gyrus and right middle occipital gyrus.3.After treatment,the brain regions with significantly enhanced VMHC value in acupuncture group were sequentially: posterior central gyrus,central sulcus cover and insula.Compared with the sham acupuncture group,the VMHC value of the lingual gyrus area in the acupuncture group significant increased after treatment.Conclusion1.The syndrome type most likely to occur in insomnia patients associated with liver is liver depression and spleen deficiency.2.The treatment of "liver depression and spleen deficiency" type insomnia with neijing "shu ci" acupuncture method can significantly improve the quality of sleep,anxiety symptoms and TCM syndromes,and its total effective rate is better than the sham acupuncture group.3.The treatment of "liver depression and spleen deficiency" type insomnia with neijing "shu ci" acupuncture method can activate the left thalamus,bilateral frontal lobe(right orbital of middle frontal gyrus and middle frontal gyrus),hippocampus,left anterior cingulate cortex and cingulate gyrus,insula,temporal lobe,left anterior wedge lobe,right wedge lobe,bilateral lingual gyrus,and regulates sleep-wake center,emotional circuits,Default Mode Network and visual processing center,which is one of the central mechanism of acupuncture treatment of insomnia. |
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