J. Acupunct. Tuina. Sci. 2010, 8 (1): 20-22 DOI: 10.

1007/s11726-010-0020-0

Special Topic Study

Clinical Observation on Acupuncture Therapy for Insomnia

ZHANG Ying-ying ()1, LIU Lan-ying ()2, MA Cheng ()1 1 Nanjing University of Traditional Chinese Medicine, Nanjing 210029, China 2 Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing 210029 China

41 (PSQI) (SCL-90)PSQISCL-90 (P0.01)SCL-90 PSQI 0.34 (P0.05) AbstractObjective: To observe the effect of acupuncture for insomnia. Methods: Based on the principle of regulating the Governor Vessel and refreshing the mind, 41 insomnia cases were treated with acupuncture. After that, the scores of Pittsburgh Sleep Quality Index (PSQI) and Symptom Checklist 90 (SCL-90) were compared before and after the treatment. Results: There were statistical differences in each component score of PSQI or SCL-90 and global scores before and after the treatment (P<0.01). The coefficient correlation between the pre-treatment and post-treatment difference of global SCL-90 scores and that of global PSQI scores was 0.34 (P<0.05). Conclusion: The needling method of regulating Governor Vessel and refreshing mind can substantially increase the sleep quality and relieve psychosomatic symptoms, and the improvement of psychosomatic symptoms was positively correlated to the sleep quality. Key WordsAcupuncture Therapy; Insomnia; Electroacupuncture CLC NumberR246.6 Document CodeA Insomnia, also known as sleeplessness, refers to an inability to obtain normal sleep. In mild cases, patients may experience difficulty in falling asleep and frequent waking during sleep with an inability to get back to sleep. In severe cases, patients may experience sleeplessness throughout the night, coupled with headache, dizziness or poor memory. With worsening of the insomnia, patients may develop increasingly severe psychosomatic symptoms. The authors treated 41 cases with the needling method of regulating the Governor Vessel and refreshing the mind. The results have been reported as follows. Criteria of Diagnosis and Therapeutic Effects for TCM Diseases and Syndromes[1].

1.2 General material

A total of 41 cases were outpatients in the Acupuncture Department, Jiangsu Provincial Hospital of Traditional Chinese Medicine from June 2007 to July 2008. The 15 male and 26 female cases aging from 25 to 77, had an average age of 50. The duration of their condition ranged from 1 month to 30 years. Of 41 cases, 15 took sleeping pills every night, 8 did intermittently and 18 never did.

2 Treatment Methods
Major points: Baihui (GV 20), Benshen (GB 13), Shenting (GV 24), Shendao (GV 11), Zhiyang (GV 9), Shenmen (HT 7) and Sanyinjiao (SP 6). Pattern-identified modification: For insomnia due to hyperactivity of liver-fire, combine with Anmian (Ex-HN 22), Xingjian (LR 2) and Taichong (LR 3);

1 Clinical Data
1.1 Diagnostic criteria This is based on the diagnosis and a pattern identification standard of sleeplessness in the
Author: ZHANG Ying-ying (1975- ), female, master of medicine

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Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2010

J. Acupunct. Tuina. Sci. 2010, 8 (1): 20-22

for internal phlegm-heat, combine with Quchi (LI 11), Fenglong (ST 40) and Neiting (ST 44); for excess fire due to yin deficiency, combine with Taixi (KI 3) and Shenshu (BL 23); for heart-spleen deficiency, combine with Xinshu (BL 15) and Pishu (BL 20) and Zusanli (ST 36); and for heartgallbladder qi deficiency, combine with Qiuxu (GB 40), Xinshu (BL 15) and Neiguan (PC 6). Method: After routine disinfection, puncture Baihui (GV 20), Shenting (GV 24) and Benshen (GB 13) 0.5 cun subcutaneously using filiform needles of 0.30 mm in diameter and 40 mm in length, followed by reinforcing manipulation by rotation. Puncture Shendao (GV 11) and Zhiyang (GV 9) 0.5-1.0 cun perpendicularly or obliquely, followed by even reinforcing-reducing manipulation; puncture Shenmen (HT 7) 0.5-1.0 cun perpendicularly, followed by reinforcing manipulation with rotation; and puncture Sanyinjiao (SP 6) 0.5-1.0 cun perpendicularly, followed by reinforcing manipulation by lifting, thrusting and rotation. Then connect bilateral Benshen (GB 13), Baihui (GV 20) and Shenting (GV 24) with XS-998B electric stimulator, using continuous wave with a frequency of 2 Hz until a slight twitching of the scalp occurs or with a sensation of slight numbness. Remove the needle after 30 min. The treatment was performed once every day, 6 times in a week and 4 weeks made up a course of treatment. The effect was statistically analyzed after one course.

3.1.2 Symptom checklist-90 (SCL-90) [4] The SCL-90 was developed to evaluate a broad range of physical and mental health. It is composed of 90 items and 10 factors, including somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticisim and others. Each component score ranges from 0 to 4. The score of each factor, average score and global score were used to evaluate the psychosomatic condition. 3.2 Statistical analysis The STATA 9.0 version software was adopted to make t-test and correlation analysis. 3.3 Treatment result It can be seen from the table 1 that except for use of sleep medications, each PSQI component score and global score showed statistical differences (P<0.01).
Table 1. Global score and each PSQI component score before and after the treatment ( x s) PSQI Sleep quality Sleep latency Sleep duration Sleep efficiency Sleep disturbance sleep medications Daytime dysfunction Global score Pre-treatment 2.490.59 2.710.60 2.510.87 2.511.00 1.390.49 1.421.36 1.781.11 14.813.20 Post-treatment 1.150.62 1) 2.070.85 1) 1.461.05 1) 1.541.31 1) 1.020.47 1) 0.981.33 1.000.89 1) 9.224.29 1)

Note: Compared with the pre-treatment result, 1) P0.01

3 Therapeutic Effect Observation

3.1 Observational markers 3.1.1 Pittsburgh Sleep Quality Index (PSQI) [2] The Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality during the previous month. It is composed of 19 self-rated questions and 5 questions rated by others, among which 18 self-rated questions can make up 7 factors, including subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of sleep medications and daytime dysfunction. Each component score ranges from 0 to 3. The component scores are summed up to produce a global score (range of 0-21). A PSQI global score above 7 is considered to be suggestive of significant sleep disturbance. The higher the score, the poorer the sleep[3].

It can be seen from the table 2 that except for phobic anxiety, each SCL-90 component score and global scale scores showed statistical differences (P<0.01). The correlation coefficient between the pre-treatment and post-treatment global SCL-90 score difference and that of PSQI was 0.34, t value was 2.196, indicating a positive correlation (P<0.05). This indicated that there was a significant correlation between the improvement of psychosomatic symptoms and sleep quality (Fig.1).

Fig.1. Improvement of PSQI

Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2010 21

J. Acupunct. Tuina. Sci. 2010, 8 (1): 20-22 Table 2 SCL-90 component score and scale scores before and after the treatment ( x s) SCL somatization Obsessive-compulsive Interpersonal sensitivity Depression Anxiety Hostility Phobic anxiety Paranoid ideation Psychoticism Others Global score Pre-treatment 5.514.99 8.815.99 5.295.33 10.549.71 6.665.75 3.492.93 1.271.78 2.783.45 4.464.35 9.493.39 58.2939.64 Post-treatment 3.224.16 1) 5.565.53 1) 2.853.90 1) 5.667.24 1) 3.814.67 1) 1.611.80 1) 0.881.55 1.712.80 1) 2.984.14 1) 5.494.03 1) 33.7635.17 1)

Note: Compared with the pre-treatment result, 1) P0.01

4 Discussion
Chinese medicine asserts that insomnia occurs as a result of excess yang and yin declining or a disharmony between yin and yang. Insomnia can be associated with the heart, liver, gallbladder, spleen, stomach, kidney and brain. The main etiological factors include fire, heat, stasis, phlegm, dampness and food retention. Since the brain houses the spirit, the authors conclude that a disorder of the brain-mind plays a major role in insomnia. The brain governs the spirit of the five Zang organs. However, the brain relies on the essence, qi, blood and body fluids transformed from the five Zang organs to function normally. Otherwise insomnia may occur. As a result, it is important to benefit the brain and regulate mind for insomnia. Points of the Governor Vessel were used to benefit the brain and regulate mind and balance yin and yang, since the major pathway of the Governor Vessel is longitudinally associated with the brain and transversely with the five Zang organs; and the branches of the Governor Vessel also connect with the five Zang organs through the Bladder Meridian. In addition, the Governor Vessel is known as the sea of yang meridians or the driving force for the physiological activities of the tissues and organs. The Zang-fu organs are governed by the meridian-qi of the Governor Vessel through the Back-Shu points. Baihui (GV 20), Shenting (GV 24) and Benshen (GB 13) are all located on the head, functioning to regulate or dredge multiple meridians and stimulate the brain extensively and multi-directionally.

Shendao (GV 11) and Zhiyang (GV 9) can regulate mind and balance yin and yang. Shenmen (HT 7), the Yuan-Primary point of the Heart Meridian, can regulate qi flow of the Heart Meridian. Sanyinjiao (SP 6) is a crossing point of the Spleen, Kidney and Liver Meridians and can regulate the spirit of the five Zang organs. The research findings indicated that the SCL-90 symptoms all alleviated after the treatment except for phobic anxiety, which may take a longer period of time to relieve. Six PSQI component scores were significantly improved after the treatment except for the use of sleep medications, which may be associated with the patients psychological dependence and short treatment time. This suggests that the use of sleep medications need to be gradually modified. Insomnia is closely related to social-psychological factors. Patients with insomnia often present with somatic symptoms, anxiety or other symptoms[5]. This also indicates that poor sleep quality may produce or aggravate psychosomatic symptoms; whereas aggravation of psychosomatic symptoms may, in turn, affect the sleep quality, leading to a vicious cycle and subsequent long-term insomnia. This study has proved that the needling method of regulating the Governor Vessel and refreshing the mind can inhibit, terminate or even reverse the above-mentioned vicious cycle, and thus improve sleep quality and regulate the psychosomatic symptoms.

References
[1] The State Administration of Traditional Chinese Medicine. Criteria of Diagnosis and Therapeutic Effects for TCM Diseases and Syndromes. Nanjing: Nanjing University Press, 1994: 19-20. [2] Buysse DJReynolds CFMonk THet al. The Pittsburgh Sleep Quality Index: a New Instrument for Psychiatric Practice and Research. Psychiatry Research1989, 28(2): 193. [3] LIU Xian-chen, TANG Mao-qin, HU Lei, et al. Reliability & Validity Study of PSQI. Chinese Journal of Psychiatry, 1996, 29(2): 103-107 [4] WANG Xiang-dong. Psychological Evaluation Scale Manual. Beijing: Chinese Mental Health Journal, 1999: 31-35. [5] YU Hai-ying, WANG Hong, CUI Shu. Psychological and Correlation Factor Analysis of Insomnia Cases. Modern Rehabilitation, 2001, 5 (10): 111. Translator: HAN Chou-ping () Received Date: October 22, 2009

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