To Observe The Clinical Effect Of Psychosomatic Therapy On Chronic Insomnia From The Perspective Of Traditional Chinese Medicine "Catharsis"

Objective:"Liver master catharsis,tune smooth sentiment and will" is an important content of the traditional Chinese medicine theory of holism of body and spirit,which plays a pivotal role in clinical diagnosis and treatment of psychosomatic diseases.However,the liver master catharsis theory is becoming more and more abstract and extensive,which is difficult to accurately grasp and apply in clinical practice.Therefore,it is of great significance for enriching TCM theory and deepening clinical practice to clarify the essence and connotation of catharsis.Chronic insomnia(CI)is one of the most common and intractable psychosomatic diseases at present,among which phlegm-heat internal disturbance combined with liver blood deficit deficiency chronic insomnia is the most common type,and there is still a lack of effective clinical program for psychosomatic co-treatment of this disease.On the basis of cognitive behavioral therapy for insomnia(CBTI),this study applied the experience prescription of professor Shu Yu Yang to treat chronic insomnia.SXF-0 has the function of clearing heat with eliminating phlegm and soothing liver with calming nerves.SXF-1 has the function of nourishing blood with calming nerves,softening liver with strengthening spleen.To observe the clinical efficacy and safety of SXF-0 and SXF-1 combined with CBTI therapy,in order to provide theoretical support and clinical basis for psychosomatic co-treatment of chronic insomnia.Methods:This study is a non-randomized concurrent controlled clinical trial.A total of 180 patients with phlegm-heat internal disturbance combined with liver blood deficit deficiency chronic insomnia who met the diagnostic criteria and inclusion criteria were divided into CBTI group,TCM treatment group and western medicine treatment group,each group with 60 patients.The CBTI group was treated with CBTI therapy alone.The TCM treatment group was given the treatment of SXF-0 and SXF-1 combined with CBTI.The western medicine treatment group was treated with dexzopiclone tablets combined with CBTI.The three groups were followed up for 4 weeks after 4 weeks of continuous intervention.Demographic data and general conditions were collected at the time of enrollment.And the index of insomnia severity(ISI)was collected at the time of treatment at 0,2,4 weeks and follow-up at 4 weeks respectively.Pittsburgh sleep quality index(PSQI),Dysfunctional beliefs and attitudes about sleep questionnaire(DBAS),Beck anxiety inventory(BAI)and Beck depression inventory(BDI)scores was collected at 0,4 weeks of treatment for intra-group and inter-group comparisons.Finally,the scores reduction rate of PSQI was used as the clinical efficacy evaluation index.To observe the efficacy and safety of different treatment schemes for chronic insomnia with phlegm-heat internal disturbance combined with liver blood deficiency.Results:1.Demographic data and general situation analysis:In this study,the ratio of male to female was 1:1.2,mainly in middle-aged population,and the medical history was ranged from 3 months to 50 years.Family factors and work factors were the two main causes of chronic insomnia,accounting for 34.9%and 24.7%respectively.Mental workers account for 77.11%,and those with a high school degree or above account for 77.11%.And 91.57%of the patients with chronic insomnia sleep in a comfortable environment;86.75%of the patients had no family history of insomnia;62.05%of the patients had no previous history.The cognitive impairment and occupational impairment caused by chronic insomnia accounted for 85.54%and 31.32%respectively.2.Intra-group comparisons:(1)The scores of PSQI was improved at the 4th week of treatment compared with before treatment(P<0.05).The scores of ISI,DBAS,BAI and BDI in all three groups improved significantly at the 4th week of treatment compared with those before treatment(P<0.001).(2)The scores of ISI was significantly improved at the 4th week of treatment compared with the 4th week of follow-up(P<0.001),suggesting that the severity of insomnia at the treatment of the three groups was lower than that during the follow-up period.3.Inter-group comparisons:(1)The clinical effective rate of CBTI group was 70.91%,the TCM treatment group was 82.14%,and the western medicine treatment group was 56.36%.The curative effect of TCM treatment group was significantly better than that of western medicine treatment group(P<0.001).(2)The safety evaluation among the three groups was grade 2,with mild adverse reactions.(3)Insomnia severity index(ISI):At the second week of treatment,the ISI scores of the TCM treatment group was significantly improved compared with the western medicine treatment group(P<0.01),indicating that the improvement of ISI in the TCM treatment group was significantly better than the western medicine treatment group.At the 4th week of treatment,the ISI scores of the CBTI group significantly improved compared with the western medicine treatment group(P<0.01),suggesting that the improvement of ISI in the CBTI group was significantly better than the western medicine treatment group.At the 4th week of follow-up,the ISI scores of the TCM treatment group was significantly improved compared with the western medicine treatment group(P<0.001),suggesting that the improvement of ISI in the TCM treatment group was significantly better than the western medicine treatment group.At the 4th week of follow-up,the ISI scores of the TCM treatment group was significantly improved compared with the CBTI group(P<0.01),suggesting that the improvement of ISI in the TCM treatment group was significantly better than the CBTI group.(4)Pittsburgh sleep quality index(PSQI):At the 4th week of treatment,the PSQI scores of the TCM treatment group was significantly improved compared with the western medicine treatment group(P<0.01),indicating that the improvement of sleep quality in the TCM treatment group was significantly better than the western medicine treatment group.At the 4th week of treatment,the PSQI scores of the CBTI group significantly improved compared with the western medicine treatment group(P<0.05),suggesting that the improvement of sleep quality in the CBTI group was better than the western medicine treatment group.(5)Dysfunctional beliefs and attitudes about sleep questionnaire(DBAS):At the 4th week of treatment,the DBAS scores of the CBTI group was significantly improved compared with the TCM treatment group(P<0.05),suggesting that the improvement of DBAS in the CBTI group was superior to the TCM treatment group.(6)Beck anxiety inventory(BAI):At the 4th week of treatment,the BAI scores of the TCM treatment group and the CBTI group was significantly improved compared with the western medicine treatment group(P<0.001),suggesting that the improvement of anxiety status of the TCM treatment group and the CBTI group was significantly better than the western medicine treatment group.(7)Beck depression inventory(BDI):There was no significant statistical difference in BDI scores among the three groups(P>0.05).Conclusions:Clinical application of SXF-0 and SXF-1 combined with CBTI therapy can effectively improve the sleep quality,reduce the severity of insomnia,relieve anxiety and depression and improve the sleep belief and attitude of phlegm-heat internal disturbance combined with liver blood deficit deficiency chronic insomnia.Its curative effect is better than western medicine group.The results are in line with the concept of psychosomatic co-governance and worthy of clinical application.