针灸治疗中风后失眠临床研究进展

Clinical Research Progress of Acupuncture and Moxibustion in the Treatment of Insomnia After Stroke

针灸治疗中风后失眠的主要方法有:针灸治疗、综合治疗等。其中,针刺治疗包括单纯针刺疗法(调督,重用阴跷、阳跷交通阴阳,子午流注针刺)、特殊配穴疗法("老十针""董氏奇穴""十三鬼穴""不寐四穴""三神针")、电针疗法等。综合疗法包括针刺结合中药、针刺结合耳穴压豆、针刺结合推拿、针刺结合艾灸、针刺结合五行音乐等。针灸治疗中风后失眠临床疗效较好,但目前研究仍存在一些问题:针灸治疗中风后失眠临床观察的样本量较小,且大多采用量表进行评价,缺少客观的分子生物学指标,因此可信度有待临床试验和循证医学的检验。针灸治疗对时机选择、穴位选择、针刺和行针手法、留针时间、针刺频率(疗效半衰期)等方面没有统一标准,今后,为提高临床疗效,应进一步深入探讨影响针灸治疗失眠的因素。

The main methods of treatment of insomnia after stroke include acupuncture,moxibustion,comprehensive treatments,etc.Among them,acupuncture treatments include simple acupuncture therapy(regulating GV,using yin heel vessel and yang heel vessel to connect yin and yang,midnight-noon ebb-flow acupuncture),special point-matching therapy("traditional acupuncture at ten points",Master Dong′s extra points,thirteen ghost points,four points for treating insomnia,"acupuncture at three magic points"),electroacupuncture,etc.Comprehensive treatments include acupuncture combined with Chinese medicinals,acupuncture combined with ear point pressing beans,acupuncture combined with massage,acupuncture combined with moxibustion,acupuncture combined with five elements music,etc.The clinical effect of acupuncture and moxibustion on insomnia after stroke is good,but there are still some problems in the current research:the sample size of clinical observation is small,and most of them are evaluated by scales,lack of objective molecular biological indicators,so the credibility needs to be tested by clinical trials and evidence-based medicine.There is no unified standard for timing,point selection,acupuncture and needling manipulation,needle retention time,and acupuncture frequency(in half-life period of curative effect).In the future,in order to improve the clinical efficacy,we should further explore the factors influencing acupuncture treatment of insomnia.