| Insomnia is a common sleep disorder.In recent years,the prevalence of liver depression and fire type insomnia has been increasing,and people’s quality of life and working condition have been seriously affected.In order to improve the sleep quality of insomnia patients,We need to explore a safe and reliable treatment.Since ancient times,traditional Chinese medicine characteristic therapy has obtained good curative effect in the treatment of insomnia.This study uses acupuncture Dong’s extra-point and ear tip bloodletting to treat liver depression and fire type insomnia.The treatment features less points,quick effect,wide range of treatment,can promote sleep recovery of insomnia patients.This paper is composed of literature research and clinical curative effect observation to evaluate the clinical efficacy and safety of Dong’s extra-point combined with ear tip bloodletting in the treatment of liver depression and fire type insomnia.To explore the clinical feasibility and efficacy of Dong’s extra-point combined with ear tip bloodletting to provide evidence-based medical basis for future scientific research.Study Ⅰ:Objective:To systematically evaluate the clinical efficacy,safety and common effective points of Dong’s extra-point,traditional Chinese medicine and western medicine in the treatment of insomnia.Methods:Computer retrieval of domestic and foreign databases,Search time from the beginning of the library to September 15,2020,A randomized controlled clinical study of Dong’s extra-point for insomnia(RCT),Selection of documents eligible for screening with reference to inclusion criteria and exclusion criteria,According to the Cochrane criteria,At the same time extract treatment methods,commonly used acupoints,effective rate,safety and other data summarized and analyzed,Use the R 4.0.2 software Meta package to analyze the relevant data,Obtain conclusions.Results:Evaluation results:A total of 13 Dong’s extra-point compared with other treatments for insomnia RCT study,In 1128 cases,There are 24 acupoints involved in this study,The top 7 main points with high frequency of use are the human emperor’s point,the earth emperor’s point,the emperor’s auxiliary point(Shenguan),the Zhenjing point,the emperor’s point,the five flower point and the fire main point.Among them,12 studies described the method of random trial,13 articles included did not clearly describe the distribution hiding,no literature clearly reported the specific blind method,and 6 articles included mentioned the situation of shedding cases and treatment measures.Meta analysis results:1.Effect of Dong’s extra-point on Total Efficiency in Clinical Treatment of Other Therapy。All the 13 literatures included in the study reported the total effective rate of clinical treatment,and the total effective rate of clinical treatment in the two groups was compared.The results showed that the treatment group was significantly increased(P<0.05),which indicated that Dong’s extra-point was more effective in the treatment of insomnia.2.Effects of Pittsburgh Sleep Quality Index(PSQI)Score and Factor ScoreThe total PSQI score of the treatment group was significantly improved compared with that of the control group(P<0.05),indicating that Dong’s extra-point could significantly improve the total PSQI score of insomnia patients,and the difference between the treatment group and the control group(P<0.05)was statistically significant.The difference was statistically significant,indicating that Dong’s extra-point could significantly improve the sleep efficiency of insomnia patients;compared with the control group,the treatment group had a statistically significant difference in improving sleep time of insomnia patients(P<0.05),indicating that Dong’s extra-point had a better effect in improving sleep quality of insomnia patients(P<0.05),the treatment group and the control group had a statistically significant difference in improving sleep quality of insomnia patients,indicating that Dong’s extra-point had a better effect in improving sleep quality of insomnia patients;and the treatment group had significantly improved daytime dysfunction compared with the control group(P<0.05)The difference was statistically significant,indicating that the treatment of insomnia by Dong’s extra-point could significantly improve the daytime function of insomnia patients.3.Publication biasThe results showed that the funnel plot was normally distributed,the distribution was relatively concentrated,and the morphology was symmetrical,which indicated that the possibility of publication bias was very small.Conclusion:Dong’s extra acupuncture has good clinical effect and safety in the treatment of insomnia.It is superior to other treatments in improving sleep time,sleep efficiency,sleep quality and daytime function.The possible effective points for the emperor point,the emperor point,the emperor’s auxiliary point,the calm point,the emperor’s point,the five flower point,the fire main point.Study Ⅱ:Objective:to observe the clinical efficacy and safety of Dong’s extra-point combined with ear tip bloodletting in the treatment of insomnia of liver depression and fire type,to explore its mechanism,and to observe the advantages of combined treatment scheme and summarize the best treatment scheme of TCM characteristics.Methods:A prospective,randomized,controlled clinical study,Patients with liver depression and fire type insomnia were randomly divided into 2 groups according to the standard of drainage,Dong’s extra-point combined with ear tip bloodletting treatment or general acupuncture treatment,The total course of treatment was 28 days.Monitoring sleep by recording sleep diaries,Pittsburgh Sleep Quality Index(PSQI)scale was used to evaluate sleep status on the first day,14 days after treatment and 28 days after treatment;Sleep related indexes were evaluated by self-rating scale(SRSS),polysomnography monitoring(PSG)and TCM syndrome integral scale on day 1 and 28 after treatment,Serum serotonin(5-HT)and melatonin(MT)levels were also detected,Statistical evaluation of changes in indicators,multi-time and multi-angle observation of comprehensive clinical efficacy.Results:1.General information versus baselineA total of 100 patients were included in this study.There was no significant difference between the two groups in sex composition,age,course of disease,marital status,education level and total score of PSQI、SRSS before treatment.There were 5 cases of abscission,including 1 case in Dongshi extra-point combined with ear tip bleeding group and 4 cases in routine acupuncture group.2.Comparison of PSQI Score and Factor ScoreThe PSQI scores of the two groups were decreased(P<0.05),and the scores of the treatment group were significantly lower than those of the control group(P<0.05).The scores of PSQI factors in the two groups before treatment(all P>0.05)were not statistically significant and comparable.The scores of sleep time,sleep quality,sleep efficiency,sleep disorder and daytime dysfunction factors in the two groups were lower than those before treatment(P<0.01,P<0.05).The score of treatment group decreased significantly after treatment(P<0.01,P<0.05).3.Clinical ComparisonCompared with the two groups,the observation group was significantly higher than the control group(P<0.05),and the observation group was more effective.4.Comparison of polysomnography(PSG)indicatorsThe sleep time and S2、SWS、NREM、REM time of the two groups were prolonged(P<0.05),the extension time of the treatment group was significantly higher than that of the control group(P<0.05),the sleep efficiency of the two groups was higher than that of the control group(P<0.05),the sleep time of the two groups was shorter(P<0.05)and the treatment group was significantly shorter than that of the control group(P<0.05)The S1 between the two groups was prolonged(P<0.05),but the treatment group was not significantly prolonged(P<0.05)compared with the control group.The arousal times of the two groups were decreased(P<0.05),and the treatment group was significantly less than the control group(P<0.05).5.Other observation indicatorsThe SRSS scores of the two groups were lower than those before treatment(P<0.05),And the score of treatment group was significantly lower than that of control group(P<0.05).Comparison of two groups of TCM syndrome scale scores,Effective rate of TCM syndrome treatment in treatment group was significantly higher than that in control group(P<0.05).Detection of melatonin(MT)levels before and after treatment,Melatonin levels increased after treatment in both groups(P<0.05),And the melatonin level increased more significantly in the treatment group(P<0.05).Detection of 5-HT levels before and after treatment,The level of 5-HT in the treatment group increased(P<0.05),There was no significant change in the level of 5-HT in the control group(P>0.05),The improvement of 5-HT content in the treatment group was significantly higher than that in the control group(P<0.05).The SL of subjective records and PSG objective monitoring SL in the two groups were longer,difference was statistically significant(P<0.05);The TST of subjective records in the PSQI scale of the two groups was shorter than PSG objective monitoring,difference was statistically significant(P<0.05).Conclusion:1.Dong’s extra-point combined with ear tip bloodletting is effective in the treatment of liver depression and fire type insomnia.The treatment can reduce sleep disorder,shorten sleep time,increase sleep time,improve sleep efficiency and improve sleep quality.The daytime function of the patients was restored without serious adverse reactions and safety.2.As a characteristic treatment method of traditional Chinese medicine,Dong’s extra-point and ear tip bloodletting have their own clinical effect of improving sleep.3.From the results of treatment,we can see that the effect of acupuncture on Dong’s extra-point combined with ear tip bloodletting to improve sleep may be related to its regulation of MT、5-HT level. |
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