软腭及腭咽弓悬吊技术在悬雍垂-腭咽成形术中的应用研究

目的观察结合软腭-腭咽弓悬吊技术的UPPP改良手术对阻塞性随眠呼吸暂停低通气综合症的疗效。方法95例阻塞性随眠呼吸暂停低通气综合症患者随机分为2组,观察组实施常规UPPP手术,对照组实施本改良UPPP手术,术前、术后6个月和1年分别行多导睡眠呼吸PSG监测,比较分析治疗效果。结果随访检测结果显示,观察组术后6个月治愈率31.37%,术后1年达41.18%,总有效率均为96.08%;对照组术后6个月治愈率18.18%,术后1年为25%,总有效率分别为81.20%和79.55%。分析结果表明,组间疗效指标差值具有统计学意义(P<0.05)。结论软腭及腭咽弓悬吊,技术操作简单,能够更加有效扩大口咽腔及鼻咽腔的有效通气容积,进一步提高阻塞性随眠呼吸暂停低通气综合症疗效,远期疗效更为满意。

睡眠对创造性思维的影响

前人已有研究表明,睡眠对创造性思维有显著影响,不同睡眠阶段对创造性思维的影响不同。拟通过从不同睡眠阶段角度出发,对国内外睡眠与创造性思维的研究进行综合梳理,探讨不同睡眠阶段对创造性思维的作用,指明睡眠不同阶段的生理特点继而提出睡眠影响创造性思维的心理机制,并在此基础上提出未来研究的可能方向。

卒中后睡眠障碍患者神经功能缺损与ASMT基因多态性相关性研究

目的探讨乙酰血清素甲基转移酶(acetylserotonin methyltransferase,ASMT)基因启动子区的两个位点(rs4446909、rs5989681)多态性与卒中后睡眠障碍(post-stroke sleep disorders,PSSD)患者神经功能缺损程度的相关性。方法将2014年1月至2015年12月在我院就诊的395例首发脑卒中患者分为PSSD组和非PSSD组,使用PSQI量表评定睡眠质量,利用多重单碱基延伸SNP分型技术检测ASMT基因,并进行基因型和等位基因频率分布的统计分析,分析其与PSSD患者神经功能缺损程度的相关性。结果神经功能轻度缺损与中重度缺损相比:rs4446909、rs5989681位点各基因型及等位基因频率在两组间分布差异无统计学意义(P>0.05);PSSD组、非PSSD组中两多态性位点各基因型频率在轻度与中重度神经功能缺损组间的分布差异无统计学意义(P>0.05)。结论 ASMT基因启动子区rs4446909、rs5989681位点多态可能不是PSSD患者神经功能缺损程度的独立危险因素。

杜甫诗作中的讹字校正(三则)

杜甫的诗集中有不少的异文,其中有些异文词义之间差别不大,不影响读者对诗作的欣赏理解。有些异文词义之间差别较大,但是因为异文所在的语境的约束力不太显著,所以读者不好取舍;还有的异文是因形近或音近而讹,这时读者可以根据语境等因素和常识,可以选定本字,排除异文。杜诗还存在因笔画脱落,或字形相近而造成的讹字现象。笔者根据理校法,排除了杜诗一处异文"老夫贪(异文:赏,费)佛日",指正"领郡辄无色""何阶子方便"二句中的讹字。

《俱舍论》中的“烦恼”与“断烦恼”

按佛教理论,众生由于烦恼的推动而造业感果,继而在轮回中往复不息。若烦恼未断,业果将生生不息。而业即使已造,若无烦恼水润也无法感果。故从轮回中解脱的根本在于"断烦恼"。公元651年,玄奘将《俱舍论》新译,其后,诸家就此展开大规模研究与注疏,至今不断。在"随眠品"中,论主世亲集中阐释"烦恼"相关内容,但其所述庞杂繁复,加上诸家注疏多有辩论,学人与此难以把握。本文意在根据玄奘译本及前辈注释,对此品中烦恼的体、相与断烦恼的方法、步骤等核心内容进行梳理与阐释。

Clinical observation of auricular needle-embedding therapy for primary insomnia

Objective:To observe the clinical efficacy of auricular needle-embedding therapy for treating primary insomnia.Methods:A total of 63 patients were randomly divided into a conventional acupuncture group and an auricular needleembedding group.The conventional acupuncture group received acupuncture at meridian points,while the auricular needle-embedding group received acupuncture at auricular points.Treatments were given once a day for 6 consecutive days,followed by a 1-day break,as a course of treatment.Both groups were treated for 2 courses.Before treatment,and after 1 course and 2 courses of treatment,the Pittsburgh sleep quality index(PSQI)score was assessed,and the efficacy was evaluated.Results:The cured and markedly effective rate and total effective rate of the auricular needle-embedding group were higher than those of the conventional acupuncture group,but there was no significant difference between the two groups(P>0.05).After 1 course of treatment,the PSQI global score and the scores of subjective sleep quality,sleep latency,sleep duration,habitual sleep efficiency,and daytime dysfunction of both groups decreased compared with those before treatment(P<0.01);there was no statistical significance in comparing the PSQI global score and individual component scores between the two groups(P>0.05).After 2 courses of treatment,the PSQI global score and the scores of sleep latency and habitual sleep efficiency of the auricular needle-embedding group decreased compared with those after 1 course of treatment(P<0.01 or P<0.05),while only the score of sleep latency of the conventional acupuncture group decreased compared with that after 1 course of treatment(P<0.05);the PSQI global score and the scores of subjective sleep quality and sleep latency of the auricular needle-embedding group were lower than those of the conventional acupuncture group(P<0.05).Conclusion:Both therapies can improve insomnia.Compared to conventional acupuncture,auricular needleembedding therapy demonstrates a therapeutic advantage in improving sleep latency and sleep quality,making it worthy of clinical promotion.

种子说的缘起

作为对传统缘起理论的发展与重构,种子熏习学说肇端于部派时期而完成于唯识大乘。基于对业力存续与烦恼潜存等问题的探讨与思考,经量部创造性地以此学说开启了缘起理论在西北印佛法中的全面转向与重新定位。本文试图对其得以揭出的内在理路作一简要疏理。

经量部的种子说及其理论困境

本文探讨了经量部的种子熏习学说。为了在过未无体的时间预设下来说明业果的关联、烦恼的潜存等问题,经量部首创了种习学说。而有部则立足于三世实有的基本立场,主要从种子的假实问题、种现熏生的异时因果问题、种子引生异熟果与等流果的差异性问题、初念无漏的生起问题等四个方面,对经部的种习学说予以了多方驳难。唯识学的种习学说,正是在充分吸收了有部相关论难的基础上形成的。

Effect of pricking Shenmai(申脉 BL 62) and Zhaohai(照海 KI 6) on daytime arousal of patients with chronic insomnia:a randomized controlled trial

Objective To compare the different efficacy in treating patients with chronic insomnia by pricking,acupuncture and estazolam.Methods Sixty patients were divided into pricking group（group A）,acupuncture group（group B） and western medicine group（group C） according to the random number table,with 20 cases in each group.In group A,hook-type needles were applied on Shenmai（申脉 BL 62） and Zhaohai（照海 Kl 6） bilaterally by piercing the skin,a small amount of mucus was squeezed and subcutaneous fibers were broken;in group B,disposable acupuncture needles were applied by needling BL 62 and Kl 6 bilaterally at the depth of 0.5 cun;in group C,patients were asked to take 1 mg estazolam once a day at bedtime.The three groups were observed for 28 days,and Epworth scores and improvement of symptoms in daytime dysfunction were recorded.Results The total effective rate of improvement of symptoms in daytime dysfunction of group A（100%,20/20） was superior to that of group B（70%,14/20）,and the differences were statistically significant（P〈0.05）;the total effective rates of group A and group B were superior to that of group C（25%,5/20）,and the differences were statistically significant（P〈0.01,P〈0.05）.In terms of Epworth scores,the efficacy of group A was significantly superior to that of group B（13.35±2.85 vs 11.10±3.88,P〈0.05）,the efficacy of group A was superior to that of group C（13.35±2.85 vs 5.30±3.28,P〈0.01）,and the efficacy of group B was superior to that of group C（11.10±3.88 vs 5.30±3.28,P〈0.01）.Epworth scores significantly decreased in each group after treatment（P〈0.01）.Conclusion The therapy of pricking BL 62 and Kl 6 for patients of chronic insomnia was effective,daytime sleepiness was relieved and daytime dysfunctions were improved,and the therapy was superior to estazolam,and more advantageous than acupuncture.

Needling method of regulating wei qi and strengthening brain for insomnia:a multicenter randomized controlled trial

Objective To observe the clinical efficacy of the needling method for regulating wei qi and strengthening brain on insomnia.Method Two hundred patients with insomnia were randomly divided into a group of regulating wei qi and strengthening brain（group A） and a group of normal acupuncture（group B）through random number table method,with 100 cases in each group.In group A,Baihui（百会 GV20）,Dazhui（大椎 GV 14）,Shenmai（申脉 BL62）,Zhaohai（照海 KI 6） and auricular points Yuanzhong（缘中 AT 2,3,4i）,and Shenmen（神门TF 4） were selected;and in group B,Sishencong（四神聪 EX-HN 1）,Shenmen（神门 HT 7）,and Sanyinjiao（三阴交 SP 6） were selected.Acupuncture was given on these points once daily for 15 days.Pittsburgh sleep quality index（PSQI） was used for scoring and curative effect was evaluated before and after treatment.Results The total effective rate was 89.0%（89/100） in group A and 65.0%（65/100） in group B with a very significant difference between the two groups（P〈0.01）;the difference of PSQI scores before and after treatment was（-9.15±5.68）in group A and（-5.64±5.73）in group B,with a very significant difference before and after treatment in the two groups（P〈0.01）.Conclusion The therapeutic effect of the needling method for regulating wei qi and strengthening brain on insomnia is superior to that of normal needling method.

Efficacy of Zhenjingdingzhi decoction in treating insomnia with Qi-deficiency of heart and gallbladder:a randomized,double-blind,controlled trial

OBJECTIVE: To evaluate the clinical efficacy of Zhenjingdingzhi decoction in treating insomnia with Qi-deficiency of heart and gallbladder.METHODS: We conducted a double-blind,randomized,controlled trial involving 100 patients with insomnia of Qi-deficiency of heart and gallbladder.Patients were randomly divided into the treatment group(n = 50) and the control group(n = 50) according to a random number table. The treatment group was given Zhenjingdingzhi decoction,while the control group was treated with Suanzaoren decoction. the pharmacological treatment lasted for 8weeks. The clinical efficacy was assessed by using Spiegel scale,Pittsburgh sleep quality index(PSQI)and Traditional Chinese Medicine(TCM) syndrome scores.RESULTS: Comparing Spiegel scores between the two groups at 4 and 8 weeks,the differences in curative effect between the two groups were both significant(both P < 0.05). The total effective rate was46% in the treatment group and 27.7% in the control group at 4 weeks,and 80% and 53.2% at 8weeks,respectively; After 8 weeks,PSQI scores showed that the total effective rates differed significantly between the two groups(P < 0.01): 84% in the treatment group and 59.6% in the control group; In improving sleep quality and sleep duration,the curative effect of the treatment group was better than that of the control group(P < 0.05).TCM syndrome,especially insomnia and palpitation,was improved better in the treatment group after 8 weeks as compared to that in the control group(P < 0.05). The total effective rate of the two groups was 84% and 66%,respectively.CONCLUSION: Zhenjingdingzhi decoction is effective and safe for the treatment of insomnia with Qi-deficiency of heart and gallbladder,especially for improving sleep quality and sleep duration.

Clinical Observation on Insomnia Treated by Wei-Defensive Qi-Regulating and Brain-Strengthening Needling Technique

Purpose： In order to make a report on 90 cases of insomnia treated by the Wei-defensive qi-regulating and brain-strengthening needling technique, as a clinical subject of the multiple center, for assessing the preliminary standardized indications and operating methods and making an initial summary for writing the draft of the technique operation. Methods： By ratio of 1：1, the patients in conformity with the criteria were randomly divided into the experimental group and control group. In the experimental group, 45 cases were treated with the Wei-defensive qi-regulating and brain-strengthening needling technique on Baihui （GV 20）, Dazhui （GV 14）, Shenmai （BL 62）, Zhaohai （KJ 6）, plus ear points. In the control group, 45 cases were treated with routine acupuncture on Sishencong （Ex-HN 1）, Shenmen （HT 7）, Sanyinjiao （SP 6）, etc. The therapeutic effects in the two groups were observed and assessed in comparison. Results： The results showed cure in 15 cases, remarkable effect in 27 cases, effect in 42 cases, failure in 6 cases, and the total effective rate in 94.4% in 90 cases of insomnia. In the three centers, the statistic management was performed based upon PSQI integral and showed significant difference （P〈0.01）, and no significant difference among various groups （P〉0.01）. Conclusion： The therapeutic effect in the treatment of insomnia by Wei-defensive qi-regulating and brain-strengthening needling technique is better than the control group and the therapeutic effect and methods in various centers are stable, without any deviation.

Curative effect of acupuncture and moxibustion on insomnia: a randomized clinical trial

OBJECTIVE: To observe the effect of acupuncture and moxibustion on insomnia and explore its mechanism. METHODS: One hundred and twenty patients were randomly divided into an experiment group and a control group. Sixty patients in the experiment group were treated once a day with acupuncture at Baihui (GV 20), Sishencong (EX-HN 1), Shenmai (BL 62), and Zhaohai (KI 6) and with moxibustion at Baihui (GV 20) and Sishencong (EX-HN 1). Sixty patients in the control group were acupunctured once a day at Shenmen (HT 7), Neiguan (PC 6), and Sanyinjiao (SP 6).The Pittsburgh Sleep Quality Index (PSQI) was used to compare sleep improvement between the two groups. RESULTS: The total effective rate was 87.7% in the experiment group and 76.3% in the control group. The PSQI scores and the total score were lower after treatment than before treatment in bothgroups. However, the reduction in the experiment group was greater than that in the control group in sleeping quality, time to fall asleep, sleeping disorder, and daytime function (P<0.05). CONCLUSION: Acupuncture and moxibustion at Baihui (GV 20), Sishencong (EX-HN 1), Shenmai (BL 62), and Zhaohai (KI 6) significantly improved insomnia symptoms in the experiment group compared with the control group.

Clinical Study on Acupuncture and Daytime Wakefulness in Insomnia Patients

Objective： To observe the effect of acupuncture on daytime wakefulness in insomnia cases. Method： Sixty primary insomnia cases were randomized into a treatment and control group, 30 cases in each group. The 30 cases in the treatment group were needled on Baihui （GV 20）, Shenting （GV 24）, Shenmen （HT 7） and Sishencong （Ex-HN 1）, whereas the 30 cases in the control group were prescribed Estazolam. After 30 d of treatment, the sleep of all cases was evaluated using the Epworth Sleepiness Scale （ESS） and Pittsburg Sleep Quality Index （PSQI）. Result： The daytime wakefulness and sleep quality in the treatment group improved faster than those in the control group. Conclusion： Acupuncture has a better effect than Estazolam in the treatment of primary insomnia.

Efficacy of Huadananshen mistura on insomnia: a randomized, double-blind, placebo-controlled, and multi-center clinical trial

OBJECTIVE: To evaluate the effect of Huadananshen mistura in clinical treatment of Chinese patients with insomnia. METHODS: In this randomized, double-blind, placebo-controlled, multi-center study, 244 patients with insomnia were randomly assigned to a placebo group, a low-dose (10 mL/day), or a high-dose (20 mL/day) mistura group. Efficacy was assessed by using the sleep dysfunction rating scale (SDRS) and Clinical Global Impression-Improvement (CGI-I) scores. Safety and tolerability assessments included emergent adverse events, laboratory tests, and electrocardiograms. RESULTS: Total SDRS scores decreased in all three groups, and there were significant differences between the placebo group and the lowand high-dose mistura groups (P=0.000). CGI-I ratings in the lowand high-dose mistura groups were sig-nificantly better than that of the placebo group (P= 0.000). Incidences of rebound insomnia were similar in all three groups (placebo group: 6.94% , low-dose mistura group: 12.99% , and high-dose mistura group: 10.96% ; P=0.475). The efficacy of Huadananshen mistura in the lowor high-dose group was significantly better than that of the placebo group (P=0.000), but with no significant difference found between the lowand high-dose mistura groups (P=0.887). The rates of adverse events were similar in the three groups (placebo 2.44% , low-dose mistura 0%, and high-dose mistura 5%; P=0.088). CONCLUSION: Huadananshen mistura is an effective and generally well-tolerated hypnotic medicine for the treatment of Chinese patients with insomnia.

Tuina for primary insomnia： a meta-analysis

Objective： To systematically evaluate the therapeutic efficacy of tuina therapy for primary insomnia. Methods： Nine Chinese and English databases were searched from the inception to May 2017 to identify randomized controlled trials （RCTs） studying tuina therapy for insomnia. The enrolled articles were all RCTs with tuina as the monotherapy or major therapy in the experiment group, with clear diagnostic criteria for primary insomnia well recognized worldwide or in China, and Pittsburgh sleep quality index （PSQI） as one of the outcome measures. Two researchers evaluated the risk of bias and quality of the enrolled studies by following Cochrane Handbook version 5.1.0. The meta-analysis was performed by RevMan version 5.3. Results： Eleven studies were included with a total of I 076 participants. The Western medication adopted in the control groups were benzodiazepine receptor agonists. The studies were all assessed as high risk of bias for blinding since blinding method was unable to be performed due to the specificity of tuina therapy; no study reported the support of fund or potential interest conflict, so they were all rated unclear for selective reporting. The meta-analysis showed that compared with other traditional Chinese medicine therapies, tuina worked more effectively in reducing the PSQI score （MD=-4.11〈O, 95% confidence interval （CI） -6.01 to -2.22, P〈0.O001）; compared with oral administration of Western medication, tuina showed more significant efficacy in reducing the PSQI score （MD=-3.42〈0, 95%CI -5.19 to -1.66, P〈0.O001）. Subgroup analysis showed that head tuina alone showed no significant difference compared with oral administration of Western medication regarding the change of PSQI score （MD=-4.19〈O, 95%CI -8.87 to 0.50, P〉0.05）; a combination of head and back tuina could more effectively reduce the PSOJ score compared with oral administration of Western medication （MD=-2.08〈O, 95%CI -3.09 to -1.06, P〈0.O001）. Conclusion： Tuina can produce more significant efficacy in treating primary insomnia compared with other traditional Chinese medicine therapies and oral administration of Western medication, especially the combination of head and back tuina.

The Needle-Rolling Therapy for Treatment of Non-organic Chronic Insomnia in 90 Cases

Objective: To evaluate the therapeutic effects of needle-rolling therapy for chronic insomnia. Methods: In the present multi-central randomly controlled clinical study, 180 cases of chronic insomnia were randomly divided into the following two groups, a treatment group (90 cases) treated by the needle-rolling therapy and a control group (90 cases) treated with clonopin. The treatment course for both the two groups was 4 weeks. The therapeutic effects were evaluated based on improvement of the TCM symptoms and the Pittsburgs's sleep-quality index (PSQI). Results: After treatment, there were significant differences between the two groups in the effective rate (P<0.05), and in the total score of PSQI and in the scores of the 4 sub-items, i.e. sleep-quality, sleep-efficiency, hypnotic and daytime function (P<0.05). Although there was no significant difference between the two groups in the effective rate after a 3-month follow-up period, significant differences still existed in the 3 sub-items of sleep-efficiency, hypnotic, and daytime function of the PSQI (P<0.05). Conclusion: As compared with hypnotics of the second generation, the needle-rolling therapy may show better therapeutic effects for chronic insomnia patients.