Systematic Review And Law Of Acupoint Selection Of Acupuncture And Moxibustion In The Treatment Of Primary Insomnia

Objective:1.To systematically evaluate the clinical efficacy and safety of acupuncture in the treatment of primary insomnia,and provide evidence-based medical evidence for clinical acupuncture in the treatment of primary insomnia.2.Systematically review the clinical research of acupuncture in the treatment of primary insomnia,summarize the rules of acupoint selection,and provide reference for clinical acupuncture in the treatment of primary insomnia.Methods:Computer retrieval of CNKI,VIP,WANFANG,China biomedical database,Cochrane Library,PubMed,Embase,web of science.Manual search of acupuncture research,Chinese acupuncture,Clinical Journal of acupuncture and moxibustion,Shanghai Journal of acupuncture and moxibustion.Objective to collect the clinical randomized controlled trials and clinical semi randomized controlled trials of acupuncture in the treatment of primary insomnia in recent ten years.Two researchers screened the eligible articles according to the inclusion and exclusion criteria.After extracting the sample size,diagnostic criteria,intervention measures,outcome indicators,adverse reactions,methodological characteristics and other information of all the included literatures,the safety evaluation was conducted.The risk of literature bias was assessed according to the evaluation criteria provided by Cochrane Collaboration Network.The clinical efficacy was meta analyzed with Review Manager 5.4.1 software.Two researchers screened the included literatures twice and removed the literatures without definite acupuncture prescription.Descriptive analysis was conducted after the information of selected acupoints,acupoint meridian tropism and acupoint location was extracted from the secondary included literatures.Using IMB SPSS statistics 25.0 and IMB SPSS modeler 18.0 as clustering analysis and association rule analysis tools,the rules of acupoint selection were analyzed and summarized,and the conclusion was drawn.Result:1.Results of quality evaluation and safety evaluation:among the 48 included literatures,3 were evaluated as high risk of bias;the rest 45 were evaluated as uncertain risk of bias.The safety evaluation showed that 1 article showed no adverse reactions;41 articles did not record whether there were adverse reactions;6 articles clearly recorded adverse reactions,the experimental group generally had no obvious adverse reactions or mild adverse reactions,and the control group had serious adverse reactions such as dizziness and fatigue.2.Meta analysis results:①the effect on clinical efficiency:the effective rate of acupuncture treatment was higher than that of Western medicine:the combined effect amount M-H OR=3.63,95%CI[2.85,4.62],(Z=10.48,P<0.00001),OR>1;the effective rate of acupuncture treatment was higher than that of traditional Chinese medicine:the combined effect amount M-H OR=3.53,95%CI[1.77,7.05],(Z=3.58,P=0.0003),The effective rate of electro acupuncture treatment was higher than that of Western medicine:combined effect dose M-H OR=2.46,95%CI[1.51,4.01],(Z=3.61,P=0.0003);the effective rate of moxibustion treatment was higher than that of western medicine:combined effect dose M-H or=3.62,95%CI[1.62,8.10],(Z=3.14,P=0.002).②Influence on PSQI score:Acupuncture and Western medicine may have advantages in improving PSQI score:combined effect MD=-2.96,95%CI[-3.88,-2.05],(Z=6.36,P<0.05),The results of sensitivity analysis were the same as before;the combined effect MD=-3.01,95%CI[-5.42,-0.61],(Z=2.46,P=0.01),the effect of forest diagram fell in the experimental group,did not intersect the equivalent line,the sensitivity analysis results were the same as before.3.Statistical analysis of acupoint selection regularity results:after the second screening,43 articles were included,including 43 acupuncture prescriptions and 61 acupoints.The most frequently used acupoint was DU20,followed by Anmian and HT7,the most frequently used meridian was Du meridian,the most frequently used part was head and neck,and the most frequently used special acupoint was five acupoints.Cluster analysis showed that BL15 was a separate group,LR3,ST36,SP6,DU29,KI6,BL20,RN12,RN16,DU24 and PC6 were the second group,EX-HN1 and Anmian were the third group,HT7 and DU20 were the fourth group.Correlation analysis results:KI6 and BL62,RN6 and RN12 have good correlation.The highest degree of support was from KI6 and BL62.Conclusion:1.Acupuncture has definite curative effect on primary insomnia.Compared with drug treatment.And acupuncture treatment of primary insomnia less adverse reactions,more safe than drug treatment.2.It is suggested to select DU20,Anmian,HT7,EX-HN1,PC6 and other acupoints for acupuncture treatment of primary insomnia.The treatment site is mainly the head,and KI6 and BL62 are usually used together.