To Explore The Clinical Efficacy Of Superficial Needling In Treating Liver-stagnation And Fire-type Insomnia And Its Regulation Mechanism On HPA Axis

Purpose This subject is based on the pathogenesis of insomnia: "hypothalamus-pituitary-adrenal axis"(HPA axis)dysfunction.The patients with insomnia of liver-stagnation and fire-type were treated with superficial needling by stimulating in main point(Zhenjingl point)and matching point(Taichong,Xingjian)for 20 days.The patients were evaluated by Pittsburgh Sleep quality Index scale(PSQI)and self-rating anxiety scale(SAS)before and after treatment.At the same time,we detect the changes of corticotropin(ACTH)and cortisol(CORT)in plasma before and after treatment,to further explore the regulating mechanism of HPA axis in patients with insomnia due to liver-stagnation and fire-type.So as to provide objective theoretical basis for clinical treatment as well as to be the guideline of clinical practice.Method Following the principle of control,randomization and equilibrium,54 patients(from Fujian University of traditional Chinese Medicine affiliated Rehabilitation Hospital)with insomnia of liver-stagnation and fire-type were randomly divided into three groups: superficial needling group,drug group and superficial needling+drug group,with 18 cases in each group.The superficial needling group was treated with superficial needling in main point(Zhenjingl point)and matching point(Taichong,Xingjian),the drug group was treated with oral esazolam tablets,and the superficial needling+drug group was treated with superficial needling combined with medicine.Intervention time is once a day,10 times as a course of treatment,a total of two courses of treatment.The outcome index of curative effect evaluation was PSQI and SAS.The levels of corticotropin and cortisol in plasma were measured by chemiluminescent method.All of the three groups were evaluated before and after treatment.Results1 Baseline comparison There were no significant difference in age,gender,course of disease,PSQI score,SAS score,the content of ACTH,CORT in plasma among the three groups before treatment(P>0.05).During the study,1 subject felt off in the superficial needling group,2 subjects felt off in the drug group,and 1 subject felt off in the superficial needling+drug group.2 PSQI(1)Compared with before treatment,the scores of Pittsburgh sleep quality index(PSQI)in the three groups after treatment were significantly lower than those before treatment,and the difference was statistically significant(P<0.05).(2)There were no differences in sleep quality and sleep disorder score among the three groups after intervention by univariate analysis of variance(P>0.05).After intervention,there were significant differences in sleep time,sleep efficiency and daytime dysfunction score among the three groups(P<0.05).After further pairwise comparative analysis,it was found that the scores of sleep time and daytime dysfunction in the superficial needling+drug group were lower than those in the superficial needling group(adjusted P=0.002,P=0.020).The score of sleep efficiency in the superficial needling+ drug group was lower than that in the drug group(adjusted P=0.019),but there were no significant differences between the other superficial needling + drug group and the drug group(P>0.05).After intervention,there were significant differences in PSQI(total score)and sleep time score among the three groups.The superficial needling +drug group was superior to the superficial needling group in improving PSQI(total score)and sleep time score(adjusted P<0.001,P<0.002),and the PSQI(total score)and sleep time score in the superficial needling + drug group were lower than those in the drug group(adjusted P=0.002,P=0.019).There were no significant differences between superficial needling group and drug group(P>0.05).3 SAS There was a significant difference among the three groups after treatment(P<0.05),and the difference among the three groups was statistically significant(P<0.05).After further pairwise comparative analysis,it was found that the superficial needling group was superior to the superficial needling group(adjusted P<0.022),and there was no significant difference between the superficial needling group and the drug group,and between the superficial needling group and the drug group(P>0.05).4 CORT and ACTH Compared with pre-treatment,the levels of plasma ACTH,CORT in the three groups decreased significantly after treatment(P<0.05),but there was no significant difference among the three groups(P>0.05).5 Comparison of clinical efficacy After two courses of treatment,0 cases were cured,1 case was markedly effective,13 cases were effective and 3 cases were ineffective in superficial needling group.The total effective rate was 82.35%.In the superficial needling group,4 cases were cured,7 cases were markedly effective,5 cases were effective,1 case was ineffective,and the total effective rate was 94.11%.The superficial needling+drug group was superior to the superficial needling group(P=0.002),the superficial needling+drug group was superior to the drug group(P=0.031).There was no significant difference between the superficial needling group and the drug group(P>0.05).Conclusion1 both superficial needling and oral esazolam tablets can effectively alleviate the symptoms of insomnia caused by liver-stagnation and fire-type,and the therapeutic effect of superficial needling is similar to that of oral esazolam tablets alone,and the effect of combination of the two methods is better than that of single method.2 superficial needling can reduce the content of ACTH,CORT in plasma and improve the symptoms of insomnia,which may be related to the regulation of HPA axis-related hormone level by superficial needling.