J. Acupunct. Tuina. Sci. 2010, 8 (1): 23-25 DOI: 10.

1007/s11726-010-0023-x

Special Topic Study

Clinical Study on Acupuncture-moxibustion Treatment for Insomnia in Heart-spleen Deficiency

LI Yang ()1, YANG Hua ()2, ZHANG Li ()2, ZHENG De-cai ()3 1 Ershadao Branch of Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510120, P. R. China 2 Institute of ZHAOs Thunder-fire Moxibustion, Chongqing 400010, P. R. China 3 Rehabilitation Department of Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510120, P. R. China

70 2 35 35 8 15 10 2 91.4% 4 11 11 9 74.2% P0.05 AbstractObjective: To observe the clinical effects of ZHAOs thunder-fire moxibustion in the treatment of insomnia in heart-spleen deficiency. Methods: 70 patients were randomly divided into two groups, 35 cases in the treatment group, managed by thunder-fire moxibustion and acupuncture, 35 cases in the control group, managed by single acupuncture treatment. Results: The results showed cure in 8 cases, remarkable effect in 15 cases, effect in 10 cases, failure in 2 cases and the total effective rate in 91.4% in the treatment group, and cure in 4 cases, remarkable effect in 11 cases, effect in 11 cases, failure in 9 cases, and the total effective rate in 74.2% in the control group. The difference is statistically significant in comparison of the total effective rates between the two groups (P0.05). Conclusion: Thunder-fire moxibustion gives a better therapeutic effect in the acupuncture treatment of insomnia in heart-spleen deficiency. Key Words Acupuncture-moxibustion Therapy; Insomnia; Syndrome Differentiation Treatment; Heart-spleen Deficiency CLC NumberR246.6 Document CodeA Insomnia usually refers to a subjective experience where the patient is not satisfied with the sleep duration and (or) quality, and this condition influences the persons daily activities, characterized by frequent inability to obtain normal sleep[1]. The authors have treated insomnia in heart-spleen deficiency with ZHAOs thunder-fire moxibustion and acupuncture. It is reported as follows. by reference of the relevant diagnosticcriteria in Chinese Classification of Mental Disorders (CCMD-2-R) [2]. Diagnostic criteria of Chinese medicine stipulated based upon the diagnostic basis of insomnia in Criteria of Diagnosis and Therapeutic Effects for TCM Diseases and Syndromes[3], the criteria of pattern identification for insomnia from Internal Medicine of Traditional Chinese Medicine[4]. The main symptoms of heart-spleen deficiency are dreamful sleep, easy waking, palpitations, poor memory, accompanied with dizziness, blurred vision, lassitude and low spirit, dull taste in food ingestion, a lusterless in facial complexion, pale

1 Clinical Materials
1.1 Diagnostic criteria Diagnostic criteria of Western medicine stipulated

AuthorLI Yang (1978- ), female, attending physician Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2010 23

J. Acupunct. Tuina. Sci. 2010, 8 (1): 23-25

tongue body, thin and white or slippery and sticky tongue coating, and a thready, weak or soft and slippery pulse. 1.2 General data Selected by main complaint of insomnia and identified as heart-spleen deficiency, 70 cases of the patients treated in the center of traditional therapies from 2007 to 2009 were randomly divided into the 2 groups by digital table, 35 cases in the treatment group, 15 males and 20 females, with the average age of 35.6 years old, and average duration of 3.3 years, and 35 cases in the control group, 16 males and 19 females, with the average age of 33.6 years old, and average duration of 3.6 years. The gender, age and average duration were not statistically different and comparable between the two groups.

2 Therapeutic Methods
2.1 Treatment group Managed by thunder-fire moxibustion plus acupuncture treatment. 2.1.1 Acupuncture Acupoints: Bilateral Xinshu (BL 15), Jueyinshu (BL 14), Pishu (BL 20), Shenmen (HT 7), Sanyinjiao (SP 6) [5]. Operation: After the patient was put in the prone position and routine disinfection was given, filiform needles in diameter of 0.35 mm and in length of 40 mm were used to puncture Xinshu (BL 15), Jueyinshu (BL 14) and Pishu (BL 20). After the arrival of the needling sensation, the needles were manipulated by the twisting technique for tonifying and retained for 30 min after the practitioner had a heaviness and tight sensation underneath the hand. With the patient in supine position, Shenmen (HT 7) and Sanyinjiao (SP 6) were punctured[2]. After the arrival of the needling sensation, the needles were manipulated by the lifting and thrusting technique for tonifying and retained after the patient had the sore, numb, distending and heaviness sensation. When the needles were retained, thunder-fire moxibustion was applied simultaneously. 2.1.2 Thunder-fire moxibustion Position and Acupoints: Yintang (Ex-HN 3) to Shangxing (GV 23), Baihui (GV 20), both ears,

Neiguan (PC 6), Shenmen (HT 7), Zusanli (ST 36), Yongquan (KI 1) and Anmian (Ex-HN 22). Operation: After the patient took the supine position, the medical practitioner ignited one piece of moxa roll and fixed it on the moxibustion tool, to heat Yintang (Ex-HN 3) to Shanghxing (GV 23), with the tool 2-3 cm away from the skin, upward and downward as one time, with nine times as one cone, pressed by the hand after each cone, till the skin became red in color and the heat sensation appeared in the deep tissues. Then, bird-pecking moxibustion was used to heat Yintang (Ex-HN 3), Shangxing (GV 23), Baihui (GV 20), with 7 times as one zhuang. Five zhuangs were used on each acupoint. Afterward, the bilateral auricular regions were heated, with a distance of 2-3 cm away from the skin, clockwise, with 10 times as one zhuang, pressed by the hand after each zhuang, till the skin around the ear became red and hot. Then, bird-pecking moxibustion was used to heat the center of the ear, with 8 times as one zhuang, with a total of 8 zhuangs, and afterward moxibustion was used above the ear of the another side. Finally, bird-pecking moxibustion was used to heat Neiguan (PC 6), Shenmen (HT 7), Zusanli (ST 36), Yongquan (KI 1) and Anmian (Ex-HN 22), about 1-2 cm away from the skin, with 8 times as one zhuang, respectively for 5 zhuangs above each acupoint. The above treatment was given once every day, with 10 sessions as one course, for 1-3 courses. 2.2 Control group Only acupuncture treatment as same as that in the treatment group was used.

3 Observation of Therapeutic Effects

3.1 Therapeutic effect criteria The criteria of the therapeutic effects was designed by reference to the criteria stipulated in Guiding Principles for Clinical Study of New Chinese Medicines[6]. Clinical Cure: After the treatment, the clinical symptoms disappear and the patient could sleep more than 6 h soundly each night and is energetic after waking up. Sleeping was restored to normal, and no recurrence was noticed in the follow-up after 3 months.

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

J. Acupunct. Tuina. Sci. 2010, 8 (1): 23-25

Remarkable Effect: Insomnia is obviously improved, and the patient could sleep continuously for about 5 h each night or the sleeping time is increased by more than 3 h, with deep sleeping time increased. Effect: The symptoms are relieved, but the sleeping hours are increased by less than 3 h than before. Failure: No obvious improvement in the symptoms of insomnia, and the continuous sleeping time are less than 3 h each night. 3.2 Statistical analysis SPSS13.0 version software packet was used for data management in the statistic methods, with Chi-square test applied for counting data and Wilcoxon test for the rank data. 3.3 Therapeutic results After 1-3 courses of treatments, the total effective rate was 91.4% in the treatment group and 74.2% in the control group, obviously higher in the treatment group than in the control group (table 1).
Table 1. Comparison of therapeutic effects between two groups (Cases) Groups n Cure 8 4 Remarkable effect 15 11 Effect Failure 10 11 2 9 Total effective rate (%) 91.41) 74.2

the Heart Meridian, and Sanyinjiao (SP 6), a crossing point of three yin meridians of foot were punctured. Yintang (Ex-HN 3), Shangxing (GV 23), Anmian (Ex-HN 22) and Zusanli (ST 36) applied with the thunder-fire moxibustion are all the effective acupoints for reinforcing and benefiting the heart and spleen. The application of the thunder-fire moxibustion with acupuncture saves time and reduces stress on the patients from acupuncture. In combination with the corresponding needling techniques on the relevant acupoints, the powerful heat from the thunder-fire moxibustion can strengthen the stimulation on the acupoints and also can strengthen the reinforcing and benefiting effects from moxibustion heat. Moreover, the warm sensation can make the patients feel relaxed, comfortable and stress-free, resulting in many patients falling asleep during the treatment of thunder-fire moxibustion. It has been proven by clinical practice that ZHAO thunder-fire moxibustion with acupuncture is effective in the treatment of insomnia in the pattern of heart-spleen deficiency and needs to be used more frequently in the clinic.

References
[1] Experts Groups of Consensus on Diagnosis and Medication Treatment. Consensus on Definition, Diagnosis and Medication Therapy of Insomnia (Draft). Chinese Journal of Psychiatry, 2006, 39(2): 141-143. [2] Society of Psychiatry of Chinese Medical Association, Brain Hospital of Nanjing Medical University. Chinese Classification and Diagnostic Criteria of Mental Disorders. Second Edition. Nanjing: Southeast University Press, 1995: 94-95 [3] The State Administration of Traditional Chinese Medicine. Criteria of Diagnosis and Therapeutic Effects for TCM Diseases and Syndromes. Nanjing: Nanjing University Press, 1994: 175 [4] WANG Yong-yan. TCM Internal Medicine. Sixth Edition. Shanghai: Shanghai Science and Technology Press, 1997: 6. [5] QIU Mao-liang. Acupuncture. Shanghai Science and Technology Press, 2000: 226-227. [6] 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. Translator: HUANG Guo-qi () Received Date: December 2, 2009

Treatment 35 Control 35

Note: Compared with control group, 1) P<0.05

4 Discussion
With the development of social economy, work and daily life have become more stressful for most people, so there has been a rise in the number of insomnia patients. The patients the author has treated are mostly the mental workers with very stressful jobs having mental fatigue, busy work and irregular eating times. Such jobs and life habits would frequently lead to a pattern with heart-spleen deficiency. In an acupuncture treatment, Xinshu (BL 15), Pishu (BL 20) and Jueyinshu (BL 14) are on the back selected firstly to reinforce and benefit the heart and spleen. After the withdrawal of the needles, Shenmen (HT 7), Yuan-Primary point of

Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2010 25