| Insomnia is one of the most common sleep disorders,it is shown as despite the adequate opportunity and circumstances for sleep,a persistent difficulty with sleep initiation,duration,consolidation,or quality that occurs,and results in some form of daytime impairment.According to epidemiological survey,the prevalence of insomnia in adults is 9%-36%.Chronic insomnia is defined by the International Classification of Sleep Disorders-3rd Edition as insomnia that occurs at least three times a week and continues for at least three months.Chronic insomnia not only affects health,quality of life,academic performance,but also related to the increased risk of depression,anxiety,dementia and other diseases.Because of the high incidence rate and high risk of insomnia,it has become a hot issue of common concern among Chinese and Western medicine scholars in recent years.The treatment of chronic insomnia with western medicine will cause adverse reactions such as amnesia,falls,cognitive impairment,respiratory depression,rebound insomnia and so on,while long-term use of sedative hypnotics will produce tolerance,addiction,withdrawal reactions and other problems,there are many limitations.Traditional Chinese medicine(TCM)treatment of chronic insomnia can be based on everyone’s situation,the effective rate is generally over 90%,and no obvious adverse reactions,which has a significant advantage.However,there are strong subjective problems in the process of syndrome differentiation and treatment of insomnia in TCM,which makes the good curative effect of TCM in the treatment of insomnia can not be further popularized and promoted.Therefore,it is of great importance to combine with modern examination technology conditions,providing simple,feasible and relatively objective measurement data for TCM doctors in the process of the syndrome differentiation.Some concepts and terms of TCM have many problems such as complex appellations,ambiguous connotation and extension,and random combination of compound symptoms,which affect the accuracy of TCM diagnosis and syndrome differentiation to some extent.Therefore,it is a pre-proposal to formulate quantitative and unified syndrome standard to realize the standardization of TCM syndrome differentiation.The Insomnia questionnaire of TCM Four-diagnosis information designed by our research group covers the symptoms and physical signs of insomnia,and the Four-diagnosis information of tongue and pulse information,which is comprehensive and easy to implement,and can provide a guarantee for the standardized TCM syndrome differentiation of insomnia.Pulse diagnosis is the most characteristic method in the Four-diagnosis methods of TCM,however,the traditional method of pulse diagnosis is difficult to master,and due to the influence of subjectivity and experience,different doctors have different syndrome differentiation.In addition,because the perceived pulse can not be recorded and preserved,the objective research of pulse diagnosis becomes necessary.The High-precision intelligent manipulator TCM pulse diagnosis information collection and analysis system independently developed by our research group has been applied to the research of pulse diagnosis information between insomnia patients and normal people in previous research.The results show that the pulse graph parameters can be used to classify the chronic insomniacs and normal people,and the distinction is accurate and specific,which lays a foundation for this research.Clinically,patients’ main complaints and questionnaire survey results are sufficient to diagnose insomnia,but some insomnia patients tend to overestimate their sleep onset latency and underestimate the total sleep time,which is called paradoxical insomnia.A study has shown that the incidence of paradoxical insomnia ranges from 8%and 66%,so it is indispensable to record the objective sleep status in sleep research.Polysomnography(PSG)can record sleep structure and continuity,obtain objective sleep information,and help physicians quantify the differences between subjective and objective sleep parameters such as sleep onset latency and total sleep time,which is of great value for the diagnosis of insomnia.Objective:To explore the characteristics and rules of pulse graph and PSG parameters of chronic insomnia with Fire Derived from Stagnation of Liver-Qi,both Heart and Spleen Deficiency,and to discover the objective reference index for clinical syndrome differentiation of chronic insomnia,so as to provide objective and quantifiable criteria for TCM syndrome differentiation of chronic insomnia.Methods:Chronic insomnia with Fire Derived from Stagnation of Liver-Qi,both Heart and Spleen Deficiency,normal subjects as the research objects,the Four-diagnosis information of TCM,pulse diagnosis information and objective sleep information of subjects were collected by Insomnia questionnaire of TCM Four-diagnosis information,High-precision intelligent manipulator TCM pulse diagnosis information collection and analysis system and PSG.The differences of TCM Four-diagnosis information,pulse graph parameters and PSG parameters among the three groups were analyzed and compared to objectively understand the characteristics of pulse graph and PSG parameters of chronic insomnia with Fire Derived from Stagnation of Liver-Qi,both Heart and Spleen Deficiency.Results:1.The TCM symptom analysis for 2 kinds of syndromes of chronic insomniaThere are a total of 21 symptoms in more than 50%of the chronic insomnia with Fire Derived from Stagnation of Liver-Qi,including 4 main insomnia symptoms and 17 other symptoms.Among the main symptoms of insomnia,the highest occurrence rate was difficulty in falling asleep,followed by easy to wake up;among other symptoms,the highest occurrence rate was post-waking fatigue and forgetfulness,followed by dry mouth,irritability,thoughtfulness and headache.There are a total of 34 symptoms in more than 50%of the chronic insomnia of both Heart and Spleen Deficiency,including 4 main insomnia symptoms and 30 other symptoms.Among the main symptoms of insomnia,the highest occurrence rate was early waking,followed by difficulty in falling asleep;among other symptoms,the highest occurrence rate was forgetfulness,followed by post-waking fatigue,dreaminess,and inattention.2.The pulse graph parameter analysis of the three groups of subjectsComparison between the chronic insomnia with Fire Derived from Stagnation of Liver-Qi and the normal subjects,the correct discrimination rate of the 4-parameter model pulse graph was 89%.A total of 20 pulse graph parameters in the 6 pulses of both hands participated in the classification,including 2 pulse position parameters,7 time domain parameters and 11 frequency domain parameters,accounting for about 10.4%of the total parameters and the cumulative number of contributions were 80 times,among which the left Cun pulse contributed the most,6 parameters participated in the classification,with 26 contributions,accounting for 32%.Followed by the left Guan pulse,3 parameters participated in the classification,with 16 contributions,accounting for 20%.Although there was only 1 parameter involved in the classification of the right Chi pulse,the contributions reached 15 times,accounting for 19%.3 parameters of left Chi pulse and 4 parameters of right cun pulse were involved in the classification,and their contributions were 8 times,each accounting for 10%.3 parameters of right Guan pulse participated in the classification,with the least contribution,7 times,accounting for 9%.Comparing the mean value of pulse position between the two groups,the results showed that the pulse position of chronic insomnia with Fire Derived from Stagnation of Liver-Qi was deeper than that of normal people.Comparison between the chronic insomnia of both Heart and Spleen Deficiency and the normal subjects,the correct discrimination rate of the 4-parameter model pulse graph was 88%.A total of 16 pulse graph parameters in the 6 pulses of both hands participated in the classification,including 1 time domain parameters and 15 frequency domain parameters,accounting for about 8.3%of the total parameters,and the cumulative number of contributions were 80 times,among which the 2 Chi pulses contributed the most,5 parameters of left Chi pulse and 2 parameters of right Chi pulse were involved in the classification,but their contributions were both 26 times,each accounting for 33%.Followed by the left Guan pulse,6 parameters participated in the classification,with 22 contributions,accounting for 27%.3 parameters of right Cun pulse participated in the classification,with 6 contributions,accounting for 7%.The parameters of left Cun pulse and right Guan pulse were not involved in the classification.Comparison between the chronic insomnia with Fire Derived from Stagnation of Liver-Qi and chronic insomnia with both Heart and Spleen Deficiency,the correct discrimination rate of the 4-parameter model pulse graph was 94%.A total of 17 pulse graph parameters in the 6 pulses of both hands participated in the classification,including 8 time domain parameters and 9 frequency domain parameters,accounting for about 8.8%of the total parameters,and the cumulative number of contributions were 80 times,among which the left Guan pulse contributed the most,4 parameters participated in the classification,with 30 contributions,accounting for 37%.Followed by the left Chi pulse,4 parameters participated in the classification,with 23 contributions,accounting for 29%.3 parameters of right Cun pulse were involved in the classification,with 18 contributions,accounting for 23%.5 parameters of left Cun pulse were involved in the classification,with 7 contributions,accounting for 8%.Only 1 parameter of right Chi pulse participated in the classification,with 2 contributions,accounting for 3%.The parameters of right Guan pulse were not involved in the classification.3.The PSG parameter analysis of the three groups of subjectsThe 21 PSG parameters among the three groups were compared,and it was found that 12 parameters,such as Total sleep time(TST),Sleep efficiency(SE),Wakefulness(W)stage,Wake after sleep onset(WASO),Non-rapid eye movement-2(N2)stage,Non-rapid eye movement-3(N3)stage,Percentage of N2 stage in total sleep time(N2%),Percentage of N3 stage in total sleep tim(N3%),Rapid eye movemen(R)stage,Percentage of R stage in total sleep tim(R%),the number of arousals and the arousal index,have statistical differences.The results of multiple comparisons showed that the 6 parameters of TST,SE,W stage,WASO,R stage,R%had statistical differences only between the chronic insomnia with Fire Derived from Stagnation of Liver-Qi and the normal subjects,and between the chronic insomnia with both Heart and Spleen Deficiency and the normal subjects.The specific performance was that TST,SE,R stage,R%of the chronic insomnia with Fire Derived from Stagnation of Liver-Qi and chronic insomnia with both Heart and Spleen Deficiency were less than normal subjects,while W stage and WASO were greater than normal subjects,indicating that chronic insomniacs have reduced TST,R stage and R%,lower SE,as well as increased W stage and WASO compared with normal people.The 6 parameters of N2 stage,N3 stage,N2%,N3%,the number of arousals and the arousal index had statistical differences only between the chronic insomnia with Fire Derived from Stagnation of Liver-Qi and chronic insomnia with both Heart and Spleen Deficiency,and between the chronic insomnia with Fire Derived from Stagnation of Liver-Qi and the normal subjects.The specific performance was that N2 stage and N2%of the chronic insomnia with Fire Derived from Stagnation of Liver-Qi were less than the chronic insomnia with both Heart and Spleen Deficiency and the normal subjects,while N3 stage,N3%,the number of arousals and the arousal index were greater than the chronic insomnia with both Heart and Spleen Deficiency and the normal subjects,indicating that patients with Fire Derived from Stagnation of Liver-Qi have reduced N2 stage and N2%,as well as increased N3 stage,N3%,the number of arousals and the arousal index.Conclusion:1.The pulse graph parameters have high accuracy in distinguishing chronic insomniacsThe correct discrimination rate of the pulse graph between the two groups of chronic insomniacs and the normal population was ≥88%,indicating that pulse graph parameters can classify chronic insomniacs and normal population with high accuracy.The pulse graph discriminate rate between chronic insomnia with Fire Derived from Stagnation of Liver-Qi and chronic insomnia with both Heart and Spleen Deficiency(94%)is higher than that of chronic insomnia with Fire Derived from Stagnation of Liver-Qi and normal subjects(89%),chronic insomnia with both Heart and Spleen Deficiency and normal subjects(88%),suggesting that pulse graph parameters may have a higher degree of differentiation between different kinds of syndrome of chronic insomnia.2.PSG parameters can provide objective evidence for the diagnosis of chronic insomnia and provide objective information for TCM syndrome differentiationCompared with the normal people,the 2 kinds of syndromes of chronic insomniacs had the characteristics of TST,R stage,R%and SE decrease,as well as W stage and WASO increase,which can be used as objective indicators for the diagnosis of chronic insomnia.Comparison between the chronic insomnia with Fire Derived from Stagnation of Liver-Qi and chronic insomnia with both Heart and Spleen Deficiency,there were significant differences in N2 stage,N3 stage,N2%,N3%,the number of arousals and the arousal index,indicating that PSG parameters could provide objective information for TCM syndrome differentiation of chronic insomnia.3.The pulse graph parameters provide useful objective information for TCM syndrome differentiation of chronic insomniaThe classification of the inclusion parameters between the chronic insomnia with Fire Derived from Stagnation of Liver-Qi and the normal population showed that the left Cun pulse contributed the most,and the left Guan pulse ranked the second,indicating that the heart and liver had a greater influence.The classification of the inclusion parameters between the chronic insomnia with both Heart and Spleen Deficiency and the normal population showed that 2 Chi pulses contributed the most,and the left Guan pulse ranked the second,indicating that the kidney and liver had a greater influence.The research results suggest that the pulse graph parameters provide useful objective information for the TCM syndrome differentiation of chronic insomnia,and can provide a certain objective basis for the clinical treatment of chronic insomnia. |
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