痰热内扰型女性原发性失眠症患者针刺方案的优选

Selection of the Optimum Protocol of Acupuncture Treatments for Female Insomnia Differentiated as Internal Harassment of Phlegm-heat Pattern

目的从失眠及相关抑郁、焦虑症状综合评价针刺治疗痰热内扰型女性原发性失眠症患者的优选方案。方法以27例痰热内扰型女性原发性失眠症患者为研究对象,采用正交设计,以体针、耳针、腹针分别结合不针刺、常规选穴、常规选穴+辨证选穴对患者进行2个疗程共20次治疗,分别在治疗前、治疗第1疗程后、第2疗程后及治疗后1个月测评患者匹兹堡睡眠质量指数(PSQI)以观察睡眠情况,测评汉密尔顿抑郁量表(HAMD)和焦虑量表(HAMA)评分以观察抑郁和焦虑情况。结果随着治疗的进行,体针、耳针对PSQI评分的改善效果呈上升趋势,而腹针呈下降趋势,治疗结束后体针和耳针对于降低PSQI评分仍然有远期疗效;体针对于HAMD评分的降低效果呈上升趋势,耳针先上升后下降,而腹针呈略下降趋势,治疗结束后体针和耳针对于降低HAMD评分仍然有远期疗效;体针对于HAMA评分的改善呈先上升后略有下降的趋势,耳针略有上升,而腹针呈下降趋势,治疗结束后体针和耳针对于降低HAMA评分仍然有远期疗效。体针常规选穴、耳穴常规选穴、腹针常规选穴+辨证选穴治疗对PSQI评分降低趋势影响最大;体针常规选穴、耳针常规选穴+辨证选穴、腹针常规选穴+辨证选穴治疗对HAMD评分降低趋势影响最大;体针不针刺、耳针常规选穴+辨证选穴、腹针常规选穴治疗对HAMA评分降低趋势影响较大。结论针刺治疗痰热内扰型女性原发性失眠症患者的优选方案为腹针(常规选穴+辨证选穴)配合体针(常规选穴)和/或耳针(常规选穴+辨证选穴)。

Objective To select the optimum protocol among body,auricular and abdominal needling methods through therapeutic effects by treating insomnia. Methods The study was designed by orthogonal method with 3 factors（ 3 needling methods） and 3 levels within each of the factor. 27 female patients of insomnia diagnosed as internal harassment of phlegm-heat syndrome through TCM syndrome differentiation accepted 20 times（ 2 courses） treatment. The therapeutic effects were evaluated by Pittsburgh sleep quality index（ PSQI）,Hamilton Depression Scale（ HAMD） scores and Hamilton Anxiety Scale（ HAMA） scores before treatment and at 1 circle,2 circles and 1 month after treatment. Results Along with the treating time increasing,body and auricular needling had better long-term effect,while abdominal needling had short-term effect. The HAMD score took a successive increase when it comes to body-acupuncture; a decrease followed by increase to ear-acupuncture; and a slight decrease to abdomen-acupuncture. And the body and ear acupuncture induced a longer post-treatment efficacy. When evaluated by HAMA,the body acupuncture exhibited an increase-then decrease fluctuation; the ear-acupuncture a slight increase trend; and abdomen-acupuncture a noteworthy decrease. The longer post-treatment still could be observed for this score. PSQI decreased in a most significant way when treated by administering routine body- or ear-acupuncture points,or routine abdomen-acupuncture ＋ the points determined by syndrome differentiation. HAMD decreased in a most significant way when treated by administering on routine body-acupuncture points,routine ear-acupuncture points ＋ the points determined by syndrome differentiation,or routine abdomen-acupuncture ＋ the points determined by syndrome differentiation. HAMA decreased in a most significant way when treated by administering on no body-acupuncture points,routine ear-acupuncture points,or routine abdomen-acupuncture ＋ the points determined by syndrome differentiation.Conclusion The recommended protocol： abdominal needling method（ fixed acupoint protocol ＋ acupoints based on pattern differentiation） combined with body needling method（ regular acupoints） and / or auricular needling method（ acupoints based on both western and TCM medicine theory）.