Clinical observation on acupuncture plus tuina for insomnia

Zhao Jian-ping (趙建平), Hong Yan (洪燕)

1 Taizhou First People’s Hospital, Zhejiang 318020, China

2 Taizhou Municipal Hospital, Zhejiang 318000, China

Clinical observation on acupuncture plus tuina for insomnia

Zhao Jian-ping (趙建平)1, Hong Yan (洪燕)2

1 Taizhou First People’s Hospital, Zhejiang 318020, China

2 Taizhou Municipal Hospital, Zhejiang 318000, China

Objective:To observe the efficacy of acupuncture plus tuina therapy for insomnia.

Acupunctue Therapy; Tuina; Massage; Insomnia

Insomnia manifests as difficulty initiating sleep at night, frequent awakening, dreaminess, lassitude and sleepiness during daytime, usually accompanied by poor concentration, slow reaction, headache and fatigue, severely affecting the quality of life and psychosomatic health of the patients. As the increased pace of life and stress from work, more and more people are suffering from insomnia. Therefore, it’s become urgent and important to find an effective and practical method to address this problem. During recent years, numerous literatures and researches have proven that acupuncture and tuina are easy-to-operate, effective, and have no side-effects[1]. We adopted acupuncture plus tuina to treat insomnia, and the report is given as follows.

1 Clinical Materials

1.1 Diagnostic criteria

1.1.1 Diagnostic criteria of traditional Chinese medicine (TCM)

By referring to the diagnostic criteria of sleeplessness in theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[2].

1.1.2 Diagnostic criteria of Western medicine

According to the diagnostic criteria of insomnia in the third edition ofClassification and Diagnostic Criteria of Mental Disorders in China(CCMD-Ⅲ)[3]: predominant complaint of sleep disturbance, with secondary symptoms including difficulty initiating sleep, light sleep, frequent awakening, inability to return to sleep after awakening, and discomfort, fatigue or sleepiness during daytime after sleep; work and social activities significantly affected by the decrease of quality and quantity of sleep; the above symptoms ≥3 times a week and lasting over 1 month; the secondary insomnia led by physical or mental disorders was excluded.

1.2 Inclusion criteria

Conforming to the above diagnostic criteria; age 20-65 years old; disease duration over 1 month; willing to participate the study and sign the informed consent form.

1.3 Exclusion criteria

Severe organic diseases involving heart, brain, liver and kidney, as well as other mental disorders; infection and fever or use of medications that may influence sleep during the recent week; women in pregnancy or lactation period; poor compliance, failed to complete the treatment, difficult to measure therapeutic efficacy, or incomplete data.

1.4 Dropout criteria

Terminated because of adverse effects or aggravation of accompanied diseases; those who quit because of unsatisfactory treatment effect or those failed to follow the whole treatment; those who quit the study.

1.5 Statistical analysis

SPSS 19.0 was adopted for data processing. Numeration data were analyzed by using Chi-square tes.P＜0.05 indicates a statistical significance.

1.6 General data

The subjects were recruited from the Acupuncture and Tuina Outpatient of Taizhou First People’s Hospital from January 2012 to October 2014. By using the random number table, they were randomized into a treatment group of 51 cases, and a control group of 49 cases, and finally 92 patients completed 3 treatment courses, 46 in each group. There were no significant differences in comparing the data of age, gender and disease duration (P＞0.05), indicating the comparability (Table 1).

Table 1. Comparison of general data

The clinical management in the two groups is shown by Figure 1.

Figure 1. Trial flow chart

2 Treatment Methods

2.1 Treatment group

2.1.1 Acupuncture treatment

Major points: Shenmen (HT 7), Sanyinjiao (SP 6), Sishencong (EX-HN 1), Baihui (GV 20), Yintang (GV 29), Taiyang (EX-HN 5), Neiguan (PC 6), Fengchi (GB 20), and Anmian [Extra, locates at the midpoint between Yiming (EX-HN 14) and Fengchi (GB 20)].

Adjunct points: Zusanli (ST 36) was added for disharmony between spleen and stomach; Taixi (KI 3) and Fuliu (KI 7) for fire excess due to yin deficiency; Taichong (LR 3) for excessive liver fire[4-5].

Method: The patient took a supine position. Needles of 0.3 mm in diameter and 25 mm in length were used to puncture at the above points after standard sterilization. Even reinforcing-reducing manipulation was applied when needling qi was obtained. The needles were retained for 30 min and manipulated once during the retaining.

2.1.2 Tuina treatment

The patient took a supine position. The practitioner first applied Rou-kneading to Taiyang (EX-HN 5) and around eyes for 3 min, and then An-pressed Baihui (GV 20) and Fengchi (GB 20) for 1 min. Afterwards, the practitioner An-pressed from Fengchi (GV 20) down to Jianjing (GB 21) for 3 times when the patient’s head was turned left, followed by the same stroke performed to the other side. Clockwise Mo-rubbing manipulation was then applied to abdomen, together with An-pressing Zhongwan (CV 12), Qihai (CV 6) and Guanyuan (CV 4) performed for 5 min. From the forehead to occiput till Dazhui (GV 14), Tui-pushing was done with five fingersand then three fingers for 5 times. Finally, Na-grasping was performed at bilateral Jianjing (GB 21)[6].

Acupuncture treatment was followed by tuina, once a day, 10 times as a treatment course, and the efficacy was evaluated after 3 courses.

2.2 Control group

Patients in the control group only received acupuncture treatment, with the same acupoints, method, and treatment course as that in the treatment group.

3 Observation of Therapeutic Efficacy

3.1 Detected measurements

The sleep quality, sleep duration and spiritual state after awakening were observed.

3.2 Criteria of therapeutic efficacy

It referred to the criteria of therapeutic efficacy in theGuiding Principles for Clinical Study of New Chinese Medicines[7].

Recovery: After treatment, the sleep duration was restored normal or night sleep duration was over 6 h, and the sleep was sound and refreshing.

Marked efficacy: Sleep was improved, and the sleep duration was over 3 h and deeper.

Improved: Symptoms were reduced, but the sleep duration was less than 3 h.

Invalid: The insomnia symptoms were not improved or even aggravated.

3.3 Treatment result

In the treatment group, 5 cases out of the 51 subjects dropped (3 cases with poor compliance, 1 was admitted into hospital because of trauma, and 1 case was lost), 46 cases completed the 3 courses of treatment, and the total effective rate was 91.3%. In the control group, 3 cases out of the 49 subjects dropped (one with poor compliance, 1 case was admitted into hospital because of cerebral infarction, and 1 case was lost), 46 cases completed the 3 courses of treatment, and the total effective rate was 73.9%. The total effective rate of the treatment group was significantly higher than that of the control group (P＜0.05), (Table 2).

Table 2. Comparison of therapeutic efficacy (case)

4 Discussion

There are many factors to blame for insomnia, mostly blaming excessive yang and insufficient yin or disharmony between yin and yang[8]. Therefore, insomnia is usually treated by reinforcing the insufficiency and reducing the excess to balance yin and yang.

Acupuncture-moxibustion and tuina therapies are the essence of traditional Chinese medicine (TCM), and currently have become crucial approaches in treating insomnia[9-10]. In this study, Sanyinjiao (SP 6) and Neiguan (PC 6) were punctured to soothe the liver and suppress yang, and achieve sedative effect. Baihui (GV 20), Sishencong (EX-HN 1), Taiyang (EX-HN 5), Yintang (GV 29) and Fengchi (GB 20) were added to refresh and calm mind, expel wind and unblock collaterals. An-pressing, Rou-kneading, Mo-rubbing, Tui-pushing manipulations were majorly used to regulate liver qi, promote blood circulation and unblock collaterals, activate meridian qi, and refresh the mind[11]. The two therapies together are well accepted by patients as they are safe, effective and painless. The results showed that after 3 courses, over 90% of the patients were able to sleep for 4-6 h per day, and the accompanied symptoms such as lassitude, headache, dizziness, worry, and anxiety were reduced or even disappeared. The efficacy of the combined treatment was significantly more significant than that of acupuncture alone, and hence it’s worth promoting in clinic. Besides, the severity of insomnia is somehow related to the patients’ emotion, so, it’s important to ask patients to keep a steady mood, form a proper diet and living habit, and do some exercises, for achieving a better treatment result[12-13].

Conflict of Interest

The authors declared that there was no conflict of interest in this article.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in this study.

Received: 25 December 2014/Accepted: 15 January 2015

[1] Zhang J. Comparison of therapeutic effects between body acupuncture and scalp acupuncture combined with body acupuncture on insomnia. Zhenjiu Linchuang Zazhi, 2013, 29(1): 13-14.

[2] State Administration of Traditional Chinese Medicine. Criteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine. Nanjing: Nanjing University Press, 1994: 3.

[3] Chinese Society of Psychiatry. Chinese Classification and Diagnostic Criteria of Mental Disorders. 3rd Edition. Jinan: Shandong Science & Technology Press, 2001: 74-75.

[4] Gao XY, Wei YL, Shao SJ, Li XR, Zhang HJ, Wang J, Ma QL, Zhao XJ, Sun WX, Wang XM. Multiple central clinical studies on the needling method for regulating Wei and strengthening brain for treatment of insomnia. Zhongguo Zhen Jiu, 2007, 27(8): 623-625.

[5] Zhou ZL, Shi X, Li SD, Guan L. Effect of scalp point penetration needling on sleep quality and sleep structure of insomnia patients. Zhongguo Zhen Jiu, 2010, 30(9): 721-724.

[6] Yu TY, Chen XZ. Tuina on head and face plus foot massage for insomnia. Anmo Yu Daoyin, 1995, 11(1): 8-9.

[7] Ministry of Health of the People’s Republic of China. Guiding Principles for Clinical Study of New Chinese Medicines. Beijing: People's Medical Publishing House, 1993: 186.

[8] Zhang BY. Internal Medicine of Traditional Chinese Medicine. Shanghai: Shanghai Science and Technology Press, 1985: 10.

[9] Dong QJ, Song CH, Li XY, Zhang BK. Acupuncture plus head and neck massage for 24 cases of chronic insomnia. Zhenjiu Linchuang Zazhi, 2013, 29(1): 25-26.

[10] Zhang H, Deng H, Jia LB, Ai SC. Multicenter randomized controlled clinical study of acupuncture plus ear apex bloodletting for treatment of insomnia. Shanghai Zhenjiu Zazhi, 2014, 33(11): 998-1000.

[11] Zhang L, Gu F. Study progress of tuina for insomnia in recent 10 years. J Acupunct Tuina Sci, 2011, 9(6): 388-396.

[12] Martha L, Phyllis E. National institutes of health state of the science conference statement on manifestations and management of chronic insomnia in adults. Sleep, 2005, 28(6): 1049-1057.

[13]Wang LS, Zhao GJ, Zhang M. Therapeutic observation on acupuncture for insomnia with brain-activating and mind-tranquilizing needling methods separately in morning and at night. Shanghai Zhenjiu Zazhi, 2013, 32(4): 280-282.

Translator: Hong Jue (洪玨)

針刺配合推拿治療失眠癥臨床觀察

目的：觀察針刺配合推拿治療失眠癥的臨床療效。方法：使用隨機數字表, 將符合納入標準的100例患者隨機分為治療組(51例)和對照組(49例)。治療組予以針刺百會、風池、完骨、神庭、安眠、內關等穴位及推拿治療; 對照組患者僅接受針刺治療。兩組均每天治療1次, 10次為1個療程, 治療3個療程后進行療效觀察和比較。結果：治療組51例中46例完成3個療程治療, 其中治愈17例, 顯效18例, 有效 7例, 無效4例,總有效率為91.3%。對照組49例中46例完成3個療程治療, 其中治愈8例, 顯效12例, 有效14例, 無效12例, 總有效率為73.9%。治療組總有效率明顯高于對照組(P＜0.05)。結論：針刺配合推拿治療失眠可以鎮靜安神, 激發經氣,療效優于單純針刺治療。

針刺療法; 推拿; 按摩; 失眠癥

R246.6 【

】A

Author: Zhao Jian-ping, bachelor, associate chief physician

Hong Yan, bachelor, attending physician.

E-mail: hanyu820503@163.com

Methods:Totally 100 eligible patients were randomized into a treatment group (n=51) and a control group (n=49) by using the random number table. The treatment group was intervened by acupuncture at Baihui (GV 20), Fengchi (GB 20), Wangu (GB 12), Shenting (GV 24), Anmian [Extra, locates at the midpoint between Yiming (EX-HN 14) and Fengchi (GB 20)], and Neiguan (PC 6) plus tuina treatment; the control group was intervened by acupuncture alone. For both groups, the treatment was given once a day, 10 sessions as a treatment course, and the efficacies were evaluated and compared after 3 treatment courses.

Results:Of the 51 subjects in the treatment group, 46 cases completed 3 treatment courses, and 17 cases were cured, 18 cases showed marked efficacy, 7 cases were improved, 4 cases had invalid result, and the total effective rate was 91.3%. Of the 49 subjects in the control group, 46 cases completed 3 treatment courses, and 8 cases were cured, 12 cases showed marked efficacy, 14 cases were improved, 12 cases had invalid result, and the total effective rate was 73.9%. The total effective rate of the treatment group was significantly higher than that of the control group (P＜0.05).

Conclusion:Acupuncture plus tuina can calm the mind and activate meridian qi in treating insomnia, and it can produce a more significant efficacy than pure acupuncture treatment.