J. Acupunct. Tuina. Sci. 2010, 8 (1): 29-31 DOI: 10.

1007/s11726-010-0029-4

Special Topic Study

Acupuncture and Insomnia: A Report of 86 Cases

YANG Zi-wei () China National Nuclear Corporation (CNNC) 404 Hospital, Jiayuguan City, Gansu 735112, P. R. China

86 1 5 1 2 d4 (Pittsburgh Sleep Quality Index, PSQI) 95.4PSQI(P<0.01) Abstract Objective: To observe the treatment effect of acupuncture on insomnia. Method: All 86 insomnia cases were treated with acupuncture once a day; 5 d make up one course of treatment. There was a 2-day interval between the two courses. After 4 courses of treatment, the therapeutic effect was analyzed, coupled with the Pittsburgh Sleep Quality Index (PSQI) global scores before and after the treatment. Result: The total effective rate was 95.4% and there was a significant difference in PSQI global scores before and after the treatment. Conclusion: Acupuncture is a safe and effective therapy for insomnia. It can improve the patients quality of life and physical function. Key WordsInsomnia; Acupuncture Therapy; Syndrome Differentiation Treatment CLC NumberR 246.6 Document CodeA Insomnia refers to nonorganic sleep and wakefulness disorder resulting from various mental or social factors. In mild cases, difficulty falling asleep or frequent waking during sleep may occur. In severe cases, sleeplessness throughout the night may occur, accompanied by anxiety, panic or depression. The incidence of insomnia (as an independent condition) is approximately 5%. The author has treated 86 cases with acupuncture. The report is now summarized as follows. transforming into fire, internal disturbance of phlegm-heat, excess fire due to yin deficiency, heart-spleen deficiency and heart-gallbladder qi deficiency. 1.2 Inclusion criteria Consistent with the above standard; Sleep latency > 30 min; PSQI global score > 7; Aged from 18-60 years; Willing to participate in the study. 1.3 Exclusion criteria Insomnia due to pain or excessive drinking and abuse or dependence of psychoactive substances; women during pregnancy or lactation; complication of severe organic or somatic conditions that may affect insomnia (chronic obstructive emphysema, apoplexy or mental disorders); and those who discontinue the participation or drop out; 1.4 General data Of 86 cases, there were 37 males and 49 females, with an average of (50.27.4) years, a mean duration of (62.26.8) months, average sleep latency of (125.358.4) min, average sleep duration of (3.40.8) h and average PSQI score of 15.22.8.

1 Clinical Data
1.1 Diagnostic criteria This is based on the diagnostic criteria of insomnia stipulated in the Diagnostic and Therapeutic Effect Standard for TCM Diseases[1] and Chinese Classification and Diagnostic Criteria of Mental Disorders, Version 3 (CCDM-3) [2] . Insomnia can be differentiated into five patterns in Chinese medicine, namely liver-qi stagnation
Author: YANG Zi-wei (1969- ), male, associate chief physician

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2 Method
2.1 Treatment method After one week of cleaning the medication prior to the treatment, the patients were prescribed An Shen Bu Xin Wan (Mind-calming & Heart-tonifying Pill), 15 pills each time, 3 times a day, coupled with acupuncture. Major points: Baihui (GV 20), Sishencong (Ex-HN 1), Yintang (Ex-HN 3), Taiyang (Ex-HN 5), Fengchi (GB 20), Shenmen (HT 7), Neiguan (PC 6), Daling (PC 7), Xinshu (BL 15), Shendao (GV 11), Shenmai (BL 62) and Zhaohai (KI 6) Modifications: For liver-qi stagnation transforming into fire, combine with Ganshu (BL 18), Geshu (BL 17) and Taichong (LR 3); For internal phlegm-heat, combine with Zhongwan (CV 12), Zusanli (ST 36), Gongsun (SP 4) and Neiting (ST 44); For excess fire due to yin deficiency, combine with Shenshu (BL 23), Taixi (KI 3) and Fuliu (KI 7); For heart-spleen deficiency, combine with Pishu (BL 20), Zusanli (ST 36) and Sanyinjiao (SP 6); For heart-gallbladder qi deficiency, combine with Ganshu (BL 18), Geshu (BL 17) and Danshu (BL 19) Method: Ask the patient to take a supine position and expose the treatment area, and puncture using needles of 0.35 mm in diameter and 25-40 mm in length, followed by lifting, thrusting and rotating manipulations. Apply reducing manipulation to Baihui (GV 20), Sishencong (Ex-HN 1), Yintang (Ex-HN 3), Taiyang (Ex-HN 5), Fengchi (GB 20), Shenmai (BL 62) and Daling (PC 7); apply reinforcing manipulation to Zhaohai (KI 6), Xinshu (BL 15), Shendao (GV 11) and Fuliu (KI 7); and apply even reinforcing-reducing manipulation to Shenmen (HT 7) and Neiguan (PC 6). Remove the needles from the above points and then ask the patient to take a prone position to puncture the points on the back using mild stimulation. Withdraw the needle immediately. The treatment was carried out once a day; 5 days make up one course of treatment. There was a 2-day interval between two treatment courses. The treatment effect was evaluated after 4 courses of treatment. 2.2 Follow-up Outpatient treatment or telephone follow-up.

2.3 Statistical analysis The measurement data was expressed with x s, using t test.

3 Result
3.1 Therapeutic effect criteria[2] Clinical recovery: Normal sleep duration or more than 6 h, normal daytime function and absence of associated symptoms; Improvement: Longer sleep duration or less than 3 additional hours of sleep and alleviated associated symptoms; Failure: No improvement at all. 3.2 PSQI evaluation Based on the relevant literature[3], the PSQI items were simplified into 6 factors, including subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, use of sleep medications and daytime physical function. Each component score ranges from 0 to 3. The component scores are summed to produce a global score (range of 0-18). The higher the score, the poorer the sleep. 3.3 Treatment result After 4 courses of treatment, 53 cases resulted in clinical recovery, 29 cases had noticeable improvement and 4 cases had no improvement at all. The total effective rate was 95.3%. The PSQI global score was changed from (15.22.8) to (5.42.1), indicating a significant statistical difference (P<0.01).

4 Discussion
Insomnia is marked by insufficiency in sleep duration, efficiency and impaired daytime function. It is mainly caused by disorder of the brain excitation and inhibition. Insomnia can be primary or secondary. Primary insomnia is not directly associated with mental factors or somatic conditions, whereas secondary insomnia is associated with pain, metabolic disorder, organic conditions, anxiety or depression. Treatment options in Western medicine include medication, psychological counseling, regular physical exercise and mental relaxation. Medications can help to break the vicious cycle, relieve the patients panic or anxiety and reduce emotional or physiological wakefulness. The most

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J. Acupunct. Tuina. Sci. 2010, 8 (1): 29-31

common medication is benzodiazepines, which can minimize the effect on rapid eye movement, improve on the ability to fall asleep, prolong the shallow sleep duration and reduce the frequency of waking. However, inappropriate use of this medication may cause excessive or persistent sedation, headache, dizziness and ataxia. Furthermore, long-term overuse may cause drug tolerance, addiction or poisoning. Sudden drug withdrawal may cause adverse reactions. Side effects have also been reported, such as excitability, restlessness, irritability, aggravated insomnia and severe anger. Consequently, it is of great significance to find a safe, effective and low-toxin alternative therapy to minimize the adverse reactions of drugs. Chinese medicine asserts that insomnia occurs as a result of yin-yang imbalance, yang excess with yin deficiency and yang failing to connect with yin. It is primarily associated with the heart, but also related to the liver, gallbladder, spleen, stomach and kidney. Clinically, there are more deficient patterns than excessive patterns. The treatment principle should be, therefore, to regulate yin, yang, qi and blood of the Zang-fu organs. During the process of treatment, the author focused on tranquilizing the heart, calming the mind and settling the will. Reducing Baihui (GV 20) can soothe the liver, dispel wind and calm the mind; reducing Fengchi (GB 20), Taiyang (Ex-HN 5) and Yintang (Ex-HN 3) can dispel wind, inhibit yang and refresh the brain; Shenshu (BL 23) and Taixi

(KI 3) can astringe the floating yang; Xinshu (BL 15) and Shenmen (HT 7) can nourish the heart and calm the mind; Zusanli (ST 36), Sanyinjiao (SP 6) and Pishu (BL 20) can tonify the heart and spleen; reducing Shenmen (HT 7) and Daling (PC 7) can reduce heart-fire; reinforcing Taixi (KI 3) and Fuliu (KI 7) can nourish kidney-yin; Xinshu (BL 15), Ganshu (BL 18) and Geshu (BL 17) can soothe the liver and promote blood circulation; and reinforcing Zhaohai (KI 6) and reducing Shenmai (BL 62) can balance yin and yang[4]. In addition, psychological counseling can also be combined. In summary, despite that the mechanism still remains to be studied, acupuncture is a safe, effective therapy for insomnia.

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: 175 [2] Chinese Society of PsychiatryChinese Classification of Mental Disorders3rd Edition. Jinan: Shandong Science & Technology Press, 2001: 118 [3] LIU Xian-chen, TANG Mao-qin, HU Lei, et al. Reliability and Validity Study of PSQI Index. Chinese Journal of Psychiatry, 1996, 29(2): 103 [4] LU Jin. Clinical Observations on Treatment of Insomnia by Acupuncture Method of Harmonizing Nutrient and Defense. Shanghai Journal of Acupuncture and Moxibustion, 2008, 27(2): 6-7. Translator: HAN Chou-ping () Received Date: December 1, 2009

Book Review

Introduction to Acupuncture for 54 Effective Disorders

Acupuncture for 54 Effective Disorders was written by HUANG Qin-feng and QI Li-zhen, and published by Shanghai Science and Technology Press in 2002. The book collected 54 common disorders in clinic from about 5 451 articles in hundreds journals between 1980 and 2000. The status of clinical acupuncture was analyzed considerably based upon a big sample, and rule of acupuncture on various disorders were summarized. Therefore, it could be used in clinic research and teaching.

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