J. Acupunct. Tuina. Sci. 2010, 8 (1): 26-28 DOI: 10.

1007/s11726-010-0026-7

Special Topic Study

Observation on Therapeutic Effects of Acupuncture Treatment for Insomnia

JIANG Yu () No.1 Hospital Affiliated to Guiyang College of Traditional Chinese Medicine, Guizhou 550000, P. R. China

:: 96 2 51 45 2 : 94.1% 77.7% P0.01 : Abstract Objective: To observe the therapeutic effects of acupuncture treatment for insomnia. Methods: Ninety-six patients with insomnia were divided into two groups by their visit order, 51 cases in the treatment group managed by acupuncture treatment, and 45 cases in the control group managed by oral administration of Estazolam tablets. After two weeks of treatment, the therapeutic effects were compared. Results: The total effective rate was 94.1% in the treatment group and 77.7% in the control group, and the difference was statistically significant in comparison of the therapeutic effects between the two groups (P<0.01). Conclusion: Acupuncture treatment is better than oral administration of Estazolam tablets for insomnia. Key WordsInsomnia; Acupuncture Therapy; Estazolam CLC NumberR246.6 Document CodeA Insomnia is a common and frequently encountered disease in the clinic and is mostly treated by sedatives and hypnotics in modern medicine. Although it works fast, the long-term administration will lead to side-effects of drug tolerance, dependence and addiction. The author has treated this disease by acupuncture clinically. The report is given as follows. discomfort and fatigue after waking up or lassitude in the daytime; the above sleeping disturbance occurs at least 3 times every week and lasts continuously for over one month; Insomnia leads to obvious distress, or decline in mental or social activities; and it does not belong to any part of the symptoms of the body or mental disturbances. 1.2 Inclusion criteria In conformity with the above diagnostic criteria, those with no current use of psychological drugs or those who have stopped over the last two weeks, those without severe somatic diseases, neurological diseases or other mental disorders. 1.3 General materials All of the 96 cases of the outpatients in conformity to the inclusive criteria were divided

1 Clinical Materials
1.1 Diagnostic criteria By reference to the criteria for insomnia in Chinese Classification of Mental Disorders (CCMD-2-R) [1], the sleeping disturbance is almost the only symptom, and other symptoms are secondary to insomnia, including difficulty falling asleep, light sleeping, easy waking, dreamful sleep, difficulty falling asleep again after waking,
Author: JIANG Yu (1958- ), female, associate chief physician

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into the 2 groups by their visit orders, 51 cases in the treatment group, including 18 males and 33 females, with the age ranging from 22 to 64 years and the duration ranging from 3 months to 6 years. Forty-five cases in the control group, including 21 males and 24 females, with the age ranging from 17 to 58 years and the duration ranging from 1 month to 5 years. The gender, age and duration between the two groups were not statistically significant and were comparable.

2 Therapeutic Methods
2.1 Treatment group Acupoints: Baihui (GV 20), Sishencong (ExHN 1), Shenmen (HT 7), Neiguan (PC 6), Taixi (KI 3), Shenmai (BL 62), Zhaohai (KI 6), and Sanyinjiao (SP 6). Operation: After the patient took a supine position to expose the needling site and disinfection was given, filiform needles of 0.35 mm in diameter and 25 mm in length were inserted swiftly and then manipulated by the lifting, thrusting, twisting and rotating techniques, with the tonifying technique applied on Baihui (GV 20), Sishencong (Ex-HN 1), Neiguan (PC 6) and Shenmen (HT 7), and the reducing technique on Zhaohai (KI 6), Sanyinjiao (SP 6) and Taixi (KI 3). The needles were retained for 15 min and manipulated once during the retaining of the needles. The treatment was given once every day. 2.2 Control Group Estazolam tablet (Chifeng Mengxing Pharmaceuticals. LTD) 1 mg, oral administration half an hour before going to bed, once every day. In the above two groups, two-week treatments made one course. The therapeutic effects were evaluated after one course. 3 Observation of Therapeutic Effects 3.1 Therapeutic effects criteria Designed by reference to the assessment of clinical effects on insomnia stipulated in Guiding Principles for Clinical Study of New Chinese Medicines[2].

Clinical cure: The sleeping times are restored to normal or are more than 6 h per night, with sound sleep, and the patient is energetic after waking up. Remarkable effect: Sleeping is noticeably improved, and the sleeping time has increased by more than 3 h, with increased sound sleep. Effect: The symptoms are relieved and the sleeping time has increased by less than 3 h. Failure: No obvious improvement after treatment or insomnia is aggravated. 3.2 Therapeutic results After the treatment for one course, the total effective rate was 94.1% in the treatment group and 77.7% in the control group. By Wilicoxon-MannWhitney test, U=696.0, Z= -3.489 bilateral test P=0.000. The differences between the two groups were statistically significant and the therapeutic effects were better in the treatment group than in the control group (table 1).
Table 1. Comparison of therapeutic effects between two groups (Cases) Groups n Cure 28 11 Remarkable Effect 14 13 Effect Failure 6 11 3 10 Total effective rate (%) 94.11) 77.7

Treatment 51 Control 45

Note: Compared with the control group, P<0.01

3.3 Case study A patient, female, 31 year old, bank staff, first visit on Nov. 10, 2007. Chief complaint and history of present illness: Insomnia for over 1 year, no any effect from administration of sleeping pills, difficulty in falling asleep, disturbed by dreams and easily woken up, difficulty in falling asleep after waking up, low spirit. Recently, the symptoms were aggravated, accompanied by palpitation, dizziness, dreams, vexation, poor appetite, 2-3 h sleep at night. Treated by the above acupuncture, one week later the patient subjectively felt as though it was not as difficult to fall asleep as before, and could sleep more than 4 h every night, and dizziness and vexation were noticeably relieved. After one course, sleeping was improved gradually, with sound sleep and fewer dreams, and the patient could sleep more than 6 h every night, felt energetic after waking up, and had a good appetite. Other clinical symptoms

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completely disappeared, and no recurrence was noticed after the follow up half a year later.

4 Discussion
Insomnia belongs to the scope of poor sleep in traditional Chinese medicine and is mainly characterized by difficulty in falling asleep, dreamful sleep and easy waking, difficulty falling asleep again after waking, and sleepless throughout the night in severe condition. The physiological theory about sleep is explained in Ling Shu (Spiritual Pivot). Normal sleep results from natural and regular transformation of yin and yang in the human body. If this rule is sabotaged, insomnia will occur, and its basic pathological change will be related to the dysfunction between yin and yang, failure of yang joining into yin, and disharmony between yin and yang due to various reasons. It is also believed in Chinese medicine that the heart belongs to fire (yang) and stays in the upper body part and the kidney belongs to water (yin) and stays in the lower body part. Water should be able to go up and fire should be able to come down. The heart fire in the upper part (yang) should come down to the kidney and the kidney water (yin) in the lower part should go upward to nourish the heart. It is pointed out in FU Qing-zhu Nv Ke (FU Qing-zhus Obstetrics and Gynecology) published in the Qing Dynasty that the coordinative balance could only be maintained by mutual communication of water and fire between the heart and kidney and harmony between yin and yang. Acupuncture is able to regulate yin and yang of the human body. In treating insomnia by acupuncture therapy, deficiency can be corrected and the surplus can be reduced by regulating yin and yang and communicating with the heart and kidney, so as to realize the status of "even yin and normal yang" in the human body. The brain is the "house of the primary spirit", a site of convergence of the essential qi and is related to the mental and spiritual activities of the human body. Baihui (GV 20) and Sishencong (Ex-HN 1) are located on the head. By the reducing technique, they are used to regulate the meridian qi of the brain and guide yang into yin to restore the balance between yin and yang[3]. Shenmen (HT 7) is a

Yuan-Primary point of the Heart Meridian, for the heart stores the spirit and mind, and can be used to soothe the heart and calm down the mind. Neiguan (PC 6), a Luo-Connecting point of the Pericardium Meridian diverges to the Triple Energizer Meridian and links with the Yin Link Vessel, so can give the effect of nourishing the heart and calming down the mind. Shenmen (HT 7) can be used to smooth the circulation of heart blood, so as to decrease heart fire and calm down the mind to aid sleep. Taixi (KI 3) is a Yuan-Primary point of the Kidney Meridian and is combined with Shenmen (HT 7) for to aid communication between the heart and kidney, so as to support water and fire mutually and balance yin and yang. By applying the reinforcing and reducing needling technique on Shenmai (BL 62) and Zhaohai (KI 6), yin and yang meridian qi of the Yin and Yang Heal Vessels can be regulated and restored. Sanyinjiao (SP 6) is an intersecting point of the three yin meridians of the foot and can be used to regulate the three yin meridians for calming down the spirit. When the above acupoints are combined, the effects include suppression of heart yang, nourishment of yin and benefits to the kidney, guiding yang into yin, and increasing communication between the heart and kidney. Judging from the clinical effects in the group, acupuncture therapy for insomnia is highly effective and safe, and can improve sleeping conditions significantly, proving better than hypnotic sedative or Estazolam tablets. Furthermore, a acupuncture does not cause any side-effects, dependence or addiction, and needs to be popularized clinically.

References
[1] HU Guo-chen. Clinical Psychiatry in Chinese and Western Medicine. Beijing: China Press of Traditional Chinese Medicine, 1998: 342-343. [2] Ministry of Health of the Peoples Republic of China. Guiding Principles for Clinical Study of New Chinese Medicines. Beijing: Peoples Medical Publishing House, 1993: 186. [3] YAN Xing-ke, YANG Bo, GAO Yang, et al. Observations on the Efficacy of "Needling Method for Tranqumization and Calming the Mind" for Insomnia Patients. Lishizhen Medicine and Materia Medica Research, 2009, 20(8): 2004-2005. Translator: HUANG Guo-qi () Received Date: December 8, 2009

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