清热化痰安神定魄方治疗痰热蕴肺证肺不藏魄型不寐疗效观察

Efficacy of decoction for clearing heat,resolving phlegm,tranquilizing spirit on insomnia of type of lung un-storing soul with syndrome of phlegm-heat accumulating lung

目的探究清热化痰安神定魄方治疗痰热蕴肺证肺不藏魄型不寐的临床疗效。方法采用随机对照试验方法,将2023年1月1日—12月31日于新疆医科大学附属中医医院全国名老中医药专家传承工作室睡眠专家门诊及神志病科门诊就诊的96例痰热蕴肺证肺不藏魄型不寐患者按1∶1比例分为中药组、西药组,每组48例,西药组给予酒石酸唑吡坦片治疗,中药组给予清热化痰安神定魄方治疗,2组治疗周期均为28 d。比较2组患者治疗前后匹兹堡睡眠质量指数量表(PSQI)6个维度评分及总分、中医证候各单项积分及总积分和治疗后PSQI总分减分率、中医证候总积分减分率,记录2组治疗期间患者不良反应发生情况、停药后复发情况及停药至复发时间。结果治疗后,2组PSQI总分及中医证候总积分均较治疗前明显降低(P均<0.05),且中药组均明显低于西药组(P均<0.05);2组PSQI量表6个维度评分、中药组中医证候各单项积分、西药组轻浅易寤和心烦易怒积分均较治疗前明显降低(P均<0.05),其中中药组PSQI量表中睡眠质量、睡眠障碍评分和中医证候中轻浅易寤、胸闷心悸、头晕或头痛、痰多口黏、口苦口臭、大便干结积分均明显低于西药组(P均<0.05)。中药组PSQI总分减分率及中医证候总积分减分率均明显高于西药组(P<0.05)。治疗期间2组均有患者出现头痛、眩晕、嗜睡,中药组总不良反应发生率明显低于西药组[9.3%(4/43)比35.7%(15/42),P<0.05]。停药后,中药组复发率明显低于西药组[16.3%(7/43)比40.5%(17/42),P<0.05],且停药后复发时间明显长于西药组(P<0.05)。结论清热化痰安神定魄方可有效改善痰热蕴肺证肺不藏魄型不寐患者睡眠质量,减轻患者临床不适症状,可降低复发率,且不良反应发生率低。

Objective It is to investigate the clinical efficacy of decoction for clearing heat,resolving phlegm,tranquilizing spirit on insomnia of type of lung un-storing soul with syndrome of phlegm-heat accumulating lung.Methods A total of 96 patients with insomnia of type of lung un-storing soul with syndrome of phlegm-heat accumulating lung who were collected from Sleep Expert Outpatient Clinic of the Inheritance Workshop of National Famous Elderly Chinese Medicine Experts and Psychiatry Outpatient Clinic of the Fourth Affiliated Hospital of Xinjiang Medical University from January 1 to December 31,2023 were divided into traditional Chinese medicine(TCM)group and western medicine group according to randomised controlled method,with 48 cases in each group.The western medicine group was treated with zolpidem tartrate tablets,and the TCM group was treated with decoction for clearing heat,resolving phlegm,tranquilizing spirit,both groups were treated for 28 days.The scores of 6 dimensions and total scores of Pittsburgh Sleep Quality Index(PSQI),the scores of each individual item and total scores of TCM syndromes before and after treatment,the total score reduction rate of PSQI and TCM syndrome after the treatment of patients in the two groups were compared,and the occurrence of adverse reactions during the treatment period,the recurrence situation after discontinuation of medication,and the time from discontinuation of medication to the recurrence of the disease of patients in the two groups were recorded.Results After treatment,the total scores of PSQI and TCM syndrome of both groups were significantly lower than those before treatment(all P<0.05),and the total scores of the TCM group were lower than those of the western medicine group(all P<0.05);the scores of 6 dimensions of PSQI of the two groups,the scores of each individual item of TCM syndromes of the TCM group,and the scores of light sleepiness and irritability of the western medicine group were significantly lower than those before treatment(all P<0.05),the scores of sleep quality and sleep disorder of PSQI,the scores of TCM symptoms such as light sleepiness,chest tightness and palpitation,dizziness or headache,phlegm and sticky mouth,bitter mouth and bad breath,and dry stools of the TC group compared were significantly lower than those of the western medicine group(all P<0.05).The reduction rates of PSQI and TCM syndromes of the TCM group were significantly higher than those of the western medicine group after treatment(both P<0.05).Headache,dizziness and drowsiness occurred in both groups during treatment,and the incidence of total adverse reactions was significantly lower in the TCM group than that in the western medicine group[9.3%(4/43)VS.35.7%(15/42),P<0.05].After discontinuation of medication,the recurrence rate was significantly lower in the TCM group than that in the western medicine group[16.3%(7/43)VS.40.5%(17/42),P<0.05],and the time from discontinuation of medication to the recurrence of the disease was significantly longer than that in the western medicine group(P<0.05).Conclusion Decoction for clearing heat,resolving phlegm,tranquilizing spirit can effectively improve the sleep quality and alleviate the uncomfortable symptoms of patients with insomnia of type of lung un-storing soul with syndrome of phlegm-heat accumulating lung,and reduce the recurrence rate and occurrence rate of adverse reactions.