Objective: To observe the clinical effect of Tongdu Tiaoshen acupuncture on chronic insomnia, and explore its possible mechanism.
Methods: A total of 60 patients with chronic insomnia were randomly divided into an observation group (30 cases) and a control group (30 cases, 1 case dropped off ). The observation group was treated with Tongdu Tiaoshen acupuncture at Baihui (GV 20), Yintang (GV 29), Shenting (GV 24), etc. once every other day, 3 times a week. The control group was treated with estazolam tablets (1 mg) orally before going to bed every night. The treatments of both groups were required 4 weeks. The Pittsburgh sleep quality index (PSQI) scores, serum gamma-aminobutyric acid (GABA) and cortisol (CORT) levels were observed before and after treatment in the two groups, and the clinical effect was compared.
Results: After treatment, the sleep quality, day dysfunction scores of PSQI in the observation group and the falling asleep time, sleep time, sleep efficiency, sleep disturbance scores and total scores of PSQI in the two groups were lower than before treatment (P<0.01, P<0.05). After treatment, the daytime dysfunction score of PSQI in the observation group was lower than that in the control group (P<0.05). After treatment, the serum GABA levels in the two groups were higher than before treatment (P<0.05), and the serum CORT levels were lower than before treatment (P<0.01). The total effective rate was 90% (27/30) in the observation group and 93.1% (27/29) in the control group, the difference was not statistically significant (P>0.05).
Conclusion: Tongdu Tiaoshen acupuncture has the same effect as western medication estazolam tablets in the treatment of patients with chronic insomnia, and has little effect on daytime dysfunction. The mechanism may be related to the increase of serum GABA level and the inhibition of the hyperactivation of hypothalamus-pituitary-adrenal (HPA) axis.
目的：观察“通督调神”针刺治疗慢性失眠症的临床疗效，并探讨其可能机制。方法：将60例慢性失眠症患者随机分为观察组（30例）和对照组（30例，脱落1例）。观察组予“通督调神”针刺治疗，穴取百会、印堂、神庭等，隔日治疗1次，每周治疗3次；对照组予艾司唑仑片1 mg睡前口服，均治疗4周。观察两组患者治疗前后匹兹堡睡眠质量指数（PSQI）量表评分、血清γ-氨基丁酸（GABA）及皮质醇（CORT）水平变化，并比较两组疗效。结果：治疗后，观察组PSQI睡眠质量、日间功能障碍评分，两组入睡时间、睡眠时间、睡眠效率、睡眠障碍评分及总分均较治疗前降低（P<0.01，P<0.05）；观察组治疗后PSQI日间功能障碍评分低于对照组 （P<0.05）。治疗后，两组血清GABA水平较治疗前升高（P<0.05），血清CORT水平较治疗前降低（P<0.01）。观察组总有效率为90.0%（27/30），对照组为93.1%（27/29），差异无统计学意义（P>0.05）。结论：“通督调神”针刺治疗慢性失眠症与西药艾司唑仑片疗效相当，且对患者日间功能影响较小，其机制可能与升高血清GABA水平，抑制下丘脑-垂体-肾上腺（HPA）轴过度活化有关。.
Keywords: acupuncture; chronic insomnia; cortisol (CORT); daytime dysfunction; gamma-aminobutyric acid (GABA); randomized controlled trial (RCT).