| ObjectiveThrough a retrospective cohort study,the curative effect of the treatment of primary insomnia of"Guangdong province TCM insomnia treatment program(2012)"was analyzed and summarized.At the same time,the system is used to retrieve the relevant literature and data of traditional Chinese and Western medicine for diagnosis and treatment of primary insomnia at home and abroad.Then a relevant literature database was established for the diagnosis and treatment of traditional Chinese and Western medicine.Based on the above research,experts'opinions are evaluated through expert assessment and forecasting(including Delphy Fa and expert meeting law),and finally form a guidline for diagnosis and treatment of traditional Chinese and Western medicine for primary insomnia.To explore the method of practice of the combination of Chinese and Western medicine.Methods1.According to the inclusion and exclusion criteria,the outpatient service medical records of primary insomnia in Guangdong Province Traditional Chinese Medical Hospital in 2015 were collected and collated.The patients treated with“Guangdong Province Traditional Chinese Medical Hospital(2012)”were assigned to the observation group;the others were assigned to the control group.The statistical analysis was made on the baseline,efficiency and treatment of the two groups.2.Based on the basic retrieval and manual retrieval strategy,we collected the published literature of primary insomnia such as the diagnosis and treatment related to Chinese and Western medicine,guidelines and norms,and set up a database for comprehensive analysis and comparison.3.Based on the above research,the questionnaire was designed,two rounds of Delphy survey and a round of expert meeting were discussed,and the results were statistically analyzed.To formulate the“guide for diagnosis and treatment of traditional Chinese and Western medicine for primary insomnia”(Draft for comments).Results1.The retrospective cohort study1.1 The baseline information:249 cases were included,159 in the observation group,63.86%,and 90 in the control group,accounting for 36.14%.Two groups of age data were compared by t test,t=1.857,P=0.065;two groups of sex data were compared,X~2 test,X~2=0.194,P=0.660.1.2 The comparison about efficiency:In the observation group,142 cases were effective,the total effective rate was 89.3%,and the effective cases in the control group were 37 cases,the total effective rate was 41.1%.X~2 test,X~2=66.059,P=0.000.1.3 The use of square frequency about Two groups of effective cases:The observation group treatment effective cases with frequency in descending order,respectively.The frequency of the top three:Rehmanniae Decoction of six ingredients with highest frequency(48 cases),Guipi Decoction(19 cases),Suanzaoren Decoction(19 cases).In the control group,the effective frequency of the effective frequency was in the descending order.The top three frequencies were:self prepared(13 cases),bupleurum plus dragon bone oyster soup(6 cases),Xiaoyao San(6 cases).2.The establishment of a database for diagnosis and treatment:We got35 articles,20 of them were Enlish,15 were Chiniese.Among them,8 were diagnosed and treated with the standard of traditional Chinese Medicine,13were recommended treatment plans,and 9 wre involved the tcm syndrome differentiation.3.The assessment of experts'opinion:We formulated the Delphy questionnaire for diagnosis and treatment of primary insomnia with integrated traditional Chinese and Western Medicine(the first and second rounds),and invited 17 experts from 9 provinces and cities to conduct expert meetings and Delphy surveys.The positive coefficients of the two rounds of Delphy Fa were100%and 92.31%,respectively.The expert authority number of the second round of consultation was between 0.83 and 0.94.The expert opinions of all kinds of experts tend to be consistent gradually,and the experts'opinions are reliable,and the guidance for diagnosis and treatment of the combination of traditional Chinese and Western medicine for primary insomnia is formed.Conclusion1.The retrospective cohort study1.1 There was no statistical difference between the two groups ofbaseline data P=0.000<0.05,and the difference was statistically significant.“Guangdong Province Traditional Chinese Medical Hospital insomnia treatment program‘(2012)'”can be used as a guide for the new blueprint becaused of a curative clinical effect.1.2 Among the effective cases in the control group,the use of Chaihu plus dragon bone oyster soup and Xiaoyao Powder is high,which will be included in the expert questionnaire for the selection of experts.1.3 The curative effect of non specialist doctors on primary insomnia is uneven.It is urgent to establish the guide for diagnosis and treatment of integrated traditional Chinese and Western medicine for primary insomnia,to enrich the diagnosis and treatment ideas of non specialist doctors,standardize the process of diagnosis and treatment,and improve the curative effect.1.4 In view of the limitations of retrospective cohort study,the clinical validation of the new guidelines recommends a multicentre randomized controlled trial,taking into account the sample size of each therapy and syndrome type.We should try to make a more objective assessment of the new guide,understand its scope,advantages and disadvantages,and further amend it to make it more consistent with the clinical requirements.2.The establishment of a database for diagnosis and treatment2.1 The guide to diagnosis and treatment of insomnia is relatively mature and evidence-based evidence is of high quality."The part of Western medicine treatment guidelines"combined with primary insomnia of traditional Chinese medicine and Western medicine will mainly refer to"diagnostic and Statistical Manual of mental disorders(Fourth Edition)"(DSM-IV),the international classification of sleep disorders(ICSD),Chinese"insomnia disorder diagnosis and treatment guidelines"and"Chinese adult insomnia diagnosis and treatment guidelines"to to further enrich the content of discussion for diagnosis and treatment,different treatment programs,to reach a consensus.2.2 The integrated traditional Chinese and Western medicine treatment scheme has been paid more and more attention to the combination of psychotherapy,traditional Chinese medicine treatment and physical therapy.But at present,the combination of Chinese and Western medicine is lacking in the combination of traditional Chinese and Western medicine and the combination of traditional Chinese and Western medicine.The formulation of the guide for diagnosis and treatment of traditional Chinese and Western medicine for primary insomnia will focus on discussing and standardizing the strategy of combination of traditional Chinese and Western medicine.2.3 There are many methods of diagnosis and treatment about TCM of primary insomnia,but the diagnostic standard and syndrome different-iation of TCM are not uniform.In view of the reliability and clinical practicability of the formulating basis,the expert questionnaire will be included in all diagnostic criteria and syndrome types for expert selection.3.The assessment of experts'opinionThere are many methods of diagnosis and treatment about TCM of primary insomnia,but the diagnostic standard and syndrome differentiation of TCM are not uniform.In view of the reliability and clinical practicability of the formulating basis,the expert questionnaire will be included in all diagnostic criteria and syndrome types for expert selection expounding the treatment strategy of combination of traditional Chinese and Western medicine.The intervention measures include traditional Chinese medicine,Chinese patent medicine,western medicine,Characteristic therapy of TCM,physical therapy and psychotherapy.The patterns of syndrome that were eventually incorporated into the new guidelines were:the six meridians mainly invoved Taiyin syndrome of disharmony and heat transformation of Shaoyin disease from,the Eight classes of syndrome differentiation is about excess syndromes and deficiency syndroms.The excess syndromes include the liver fire harassing the heart type and liver stagnation fire,phlegm heat syndrome,blood stasis syndrome,stomach disharmony syndrome and the deficiency of spleen two deficiency,deficiency of heart qi and gallbladder Qi,disharmony of heart and kidney,Yin Deficiency Hyperactivity of fire are the deficiency syndroms.The formulation of the guide is scientific and operable,which is beneficial to the development of standardization of diagnosis and treatment of traditional Chinese medicine. |
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