针灸治疗失眠症现代研究概况

Overview of Modern Research on Acupuncture and Moxibustion in the Treatment of Insomnia

针灸治疗失眠症多以特定穴位、循经刺激、重点配穴为主,主要通过调节神经系统递质释放程度从而达到纠偏的目的,其神经调节的机制有:调节“神经-内分泌-免疫系统”发挥调控作用;调节下丘脑-垂体-肾上腺轴。针对失眠症取穴最多的经脉为任脉、足太阳膀胱脉经、督脉,针刺部位主要以头部穴位为主。针灸治疗失眠症的联合疗法有:推拿疗法、电针疗法、穴位注射疗法、耳针疗法、特殊针法(主要包括平衡针法、脐针、火针、梅花针等)等。失眠症日久,患者多伴有其他基础疾病,在治疗失眠症的同时,应注重综合治疗。针灸治疗失眠症临床疗效的评价多以评分量表进行衡量,但对量表的选择无统一标准,临床疗效无法进行多中心对比,评分依赖于患者的主观感受,缺乏客观、定量的临床指标;多数临床报道多注重近期效果,对远期临床效果的评价较少,缺乏远期的疗效评价;缺乏现代医学的临床机制研究,针灸治疗失眠症目前仍处于临床研究阶段,尚缺乏深入机制研究,尚不能通过分子水平阐述其治疗机理。文献报道大多为临床非盲随机对照研究,且临床研究样本量偏小,今后应进行多中心、大样本的双盲随机对照研究,深入研究其作用机制、治疗机理,制定客观的临床观察指标,对远期临床疗效进行评价。

Acupuncture and moxibustion is mainly used to treat insomnia with specific points,stimulation along the meridians,and key point matching.The purpose of correction is mainly achieved by regulating the release of neurotransmitters in the nervous system.Its neuromodulation mechanism includes:regulating the"nerve-endocrine-immune system"to play a regulatory role;regulating the hypothalamic-pituitary-adrenal axis.The most commonly selected acupoints for insomnia are from the conception vessel,the foot greater yang bladder meridian,and the govern vessel.The main acupuncture points are the head points.The combined therapies of acupuncture and moxibustion for insomnia include massage therapy,electroacupuncture therapy,acupoint injection therapy,ear acupuncture therapy,and special acupuncture(mainly including balance acupuncture,navel acupuncture,fire acupuncture,plum blossom acupuncture,etc.).For patients with long-time insomnia and other underlying diseases,comprehensive treatment should be emphasized.However,the evaluation of the clinical efficacy of acupuncture and moxibustion in treating insomnia is mostly measured by the scoring scale,but there is no unified standard for the selection of the scale,and the clinical efficacy cannot be compared in multiple centers.The scoring depends on the subjective feelings of the patients,lacking objective and quantitative clinical indicators.Most clinical reports focus more on short-term outcomes,with less evaluation of long-term clinical outcomes and a lack of long-term efficacy evaluation.There is a lack of research on the clinical mechanism of modern medicine.The treatment of insomnia by acupuncture and moxibustion is still in the stage of clinical research.There is still a lack of in-depth mechanism research,and its therapeutic mechanism cannot be explained at the molecular level.Most of the literature reports are clinical non-blind randomized controlled studies,and the sample size of clinical studies is relatively small.Therefore,it is necessary to conduct multi-center,large sample,double blind randomized controlled studies in the future to deeply study its mechanism of action and treatment,develop objective clinical observation indicators,and evaluate long-term clinical efficacy.