不同灸量透灸治疗心脾两虚型失眠临床研究

目的:

观察针刺结合40min透灸与60min透灸背俞穴治疗心脾两虚型失眠的临床疗效差异。

方法:

将60例心脾两虚型失眠患者随机分为40 min透灸组（A组）和60 min透灸组（B组）。两组均予针刺治疗,穴取厥阴俞、心俞、膈俞、脾俞、神道、至阳穴,然后选用艾灸箱,于患者背部透灸法施灸,灸至局部皮肤均匀汗出、潮红为度,A组透灸40min,B组透灸60min。两组均每日治疗1次,5次为一疗程,每周治疗5次,休息2d,连续治疗4个疗程。观察记录两组患者治疗前后匹兹堡睡眠质量指数量表（PSQI）评分、中医症状量表评分,及升温期、有效期、降温期的平均温度,知热温度、舒适温度、知降温度、用药情况,并比较两组的临床疗效。

结果:

B组总有效率为96.6%（28/29）,高于A组的89.3%（25/28,P＜0.05）。A组治疗后PSQI总分及睡眠质量、睡眠时间、睡眠效率、睡眠障碍、日间功能障碍评分及中医症状量表总分及其中的晨起困倦、心悸、健忘、食欲评分均较治疗前降低（均P＜0.05）;B组治疗后PSQI总分及各因子评分、中医症状量表总分及各因子评分均较治疗前降低（均P＜0.05）;治疗后两组患者PSQI总分及各因子评分、中医症状量表总分及各因子评分比较差异均有统计学意义（均P＜0.05）。结论:针刺结合透灸法治疗可改善心脾两虚型失眠患者症状,且60min透灸组效果更优,延长透灸时间可改善患者的入睡时间及睡眠质量。

OBJECTIVE: To observe the clinical efficacy differences between acupuncture combined with 40-min penetration moxibustion and 60-min penetration moxibustion at back-shu points for insomnia of insufficiency of heart and spleen type.

METHODS: Sixty patients of insomnia with insufficiency of heart and spleen type were randomly assigned into a 40-min group and a 60-min group. The two groups were treated with acupuncture at Jueyinshu (BL 14), Xinshu (BL 15), Geshu (BL 17), Pishu (BL 20), Shendao (GV 11) and Zhiyang (GV 9). With moxibustion box, the penetration moxibustion was applied at the back until sweating and redness on the back. The moxibustion was given for 40 min in the 40-min group and 60 min in the 60-min group. The treatment was given once a day, five days per week. Each session was consisted of 5 treatments, with an interval of 2 days between session and totally 4 consecutive weeks were provided. The Pittsburgh sleep quality index (PSQI), TCM symptom scale were observed and recorded before and after treatment in the two groups. The even temperature at raising period, effective period, reducing period, as well as minimum high temperature, comfortable temperature, minimum cold temperature and medication status were compared; also the effect was compared between the two groups.

RESULTS: The total effective rate was 96.6% (28/29) in the 60-min group, which was higher than 89.3% (25/28) in the 40-min group (P<0.05). Compared before treatment, the total score of PSQI and sleep quality, sleep time, sleep efficiency, sleep disorder, daytime dysfunction as well as the total TCM symptom score and its drowsiress in the morning, palpitation, amnesia, appetite were reduced after treatment in the 40-min group (all P<0.05). After treatment, the total score and each score of PSQI as well as total score and each score of TCM symptom scale were reduced after treatment in the 60-min group (all P<0.05). After treatment, the total score and each score of PSQI as well as total score and each score of TCM symptom scale were significantly different between the two groups (all P<0.05).

CONCLUSIONS: Acupuncture combined with penetration moxibustion can improve the symptomsof insomnia with insufficiency of heart and spleen type, which is more significant in the 60-min group, indicating prolonged time of penetration moxibustion can improve sleep latency.