| Objective To investigate the therapeutic effect of acupuncture combined with filiform-fire on insomnia of both heart and spleen deficiency type,and to study the brain function mechanism of acupuncture combined with filiform-fire in the treatment of insomnia of both heart and spleen deficiency type by resting state functional magnetic resonance imaging(rs-f MRI)with Amplitude of Low Frequency Fluctuation(ALFF)and Regional Homogeneity(Re Ho).Methods 75 eligible insomnia patients with deficiency of both heart and spleen were randomly divided into two groups,including the observation group(acupuncture combined with filiform-fire group)and the control group(acupuncture group).The observation group was treated with acupuncture combined with filiform-fire,while the control group was treated with filiform needle.The two groups were treated for 30 minutes each time,once a day,one course of treatment consisted of 6 days.All the cases were treated for 2 courses while took a rest between the courses.Pittsburgh Sleep Quality Index(PSQI),Insomnia Severity Index(ISI),Fatigue Severity Scale(FSS),Baker Anxiety Inventory(BAI)and Baker Depression Inventory(BDI)were assessed before treatment,after treatment and 2 weeks after treatment.In the two groups,resting-state functional magnetic resonance imaging was performed in some selected cases before and after treatment.The brain function mechanism of insomnia treated by acupuncture combined with filiform fire needle was studied by Amplitude of Low Frequency Fluctuation(ALFF)and Regional Homogeneity(Re Ho)methods.Results 70 cases were finally completed the research,including 36 cases in observation group with 3 cases in abscission;34 cases in control group with 2 cases in abscission rate.There was no significant difference between the two groups in baseline,including gender,age,course of disease,and observation index(P > 0.05).The total effective rate was 88.9% in the observation group and 76.5% in the control group.Compared with the control group,the total effective rate in the observation group was better than that in the control group(P < 0.05).The PSQI,ISI,FSS,BAI and BDI scores of insomnia patients in the two groups decreased after treatment and follow-up compared with those before treatment,and the difference was statistically significant(P < 0.05),but the PSQI,ISI and BDI scores of the two groups increased to a certain extent after treatment and follow-up(P < 0.05),while the FSS and BAI scores of the two groups had no difference after treatment and follow-up(P > 0.05).In comparison the two groups,the PSQI,ISI,FSS,BAI and BDI scores of the two groups were significantly different after treatment and follow-up(P < 0.05),and the scores of each scale in the observation group decreased more.Thirty-two cases were examined by f MRI before and after the treatment,but 9 cases were excluded because of the operation problems during the scanning process.Furthermore,during the scanning process,the head movements of the cases were too large to be corrected,therefore,7 cases were excluded.Finally,17 cases were retained,including 9 cases in the observation group and 8 cases in the control group.In the observation group,the left inferior temporal gyrus(LTIG)whose ALFF value increased after treatment compared with that before treatment decreased mainly in the left anterior cingulate gyrus and paracingulate gyrus,the cortex around the right talus fissure,and the left medial superior frontal gyrus.In the observation group,the main brain areas whose Re Ho values increased between after treatment and before treatment were right dorsolateral superior frontal gyrus,left medial superior frontal gyrus,left anterior cingulate and paracingulate brain,and the cortex around left talus fissure;Meanwhile,the main brain areas whose Re Ho values decreased were left middle temporal gyrus,left angular gyrus and left superior marginal gyrus.In the control group,the main brain areas with increased Re Ho values were right middle temporal gyrus,right parahippocampal gyrus,right middle occipital lobe and right middle frontal gyrus,and the main brain areas with decreased Re Ho values were left insula.Compared with the control group,ALFF values increased both in the observation group and the control group.Compared with the control group,both the ALFF value and Re Ho value were increased.The main brain areas with ALFF value increased were left supplementary motor area,right dorsolateral superior frontal gyrus;and the main brain areas were Re Ho value increased were left middle temporal gyrus,right inferior temporal gyrus and left superior temporal gyrus.Conclusion 1.Acupuncture combined with filiform-fire and only acupuncture has a definite effect on insomnia of deficiency of both heart and spleen.The clinical effective rate of acupuncture combined with filiform-fire is higher than that of only acupuncture.2.Acupuncture combined with filiform-fire can improve the degree of fatigue,anxiety and depression of insomnia patients with deficiency of both heart and spleen,and the improvement of fatigue and anxiety sustainable.3.Acupuncture combined with filiform-fire needle may play a therapeutic role by activating left infratemporal gyrus and negatively activating left and right Anterior cingulate and paracingulate gyrus,peri-right talar fissure cortex and other visual-auditory and emotional related brain areas,and then reducing patients’ response to the outside world during sleep,while inhibiting negative emotional activities and improving daytime function of the patients. |
