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Title: [Clinical effect of acupuncture based on the specific response of jing-well point for intractable insomnia: a randomized controlled trial].
Author: Chu W, Gao X, Cao Y, Gao L, Li Y, Li Y, Li W, Qi S, Qian J.
Journal: Zhongguo Zhen Jiu; 2024 Jul 12; 44(7):779-86. PubMed ID: 38986590.
Abstract:
OBJECTIVE: To evaluate clinical effect and safety on the basis of detecting the specific response of jing-well point in treatment of intractable insomnia with acupuncture by meridian differentiation. METHODS: Sixty-four patients with intractable insomnia were randomized into an observation group (32 cases, 1 case dropped out and 1 case was eliminated) and a control group (32 cases, 1 case was eliminated). In the observation group, the meridian imbalance value detected at the jing-well point was taken as the evidence so that the corresponding yuan-source and back-shu points were stimulated with acupuncture. In the control group, the routine acupuncture was operated at Baihui (GV 20), Sishencong (EX-HN 1), and bilateral Shenmen (HT 7), Sanyinjiao (SP 6), Shenmai (BL 62) and Zhaohai (KI 6). Besides, the detection at jing-well point was performed for blindness in the control group. In the two groups, the interventions were delivered once daily, 5 times a weeks and for consecutive 4 weeks. In the two groups, the scores of Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI) and the TCM symptom scale were observed before treatment and after 2 and 4 weeks of treatment; the clinical effect and safety were evaluated after treatment; the changes of meridian imbalance value were observed before and after treatment and the correlation analysis with the total score of PSQI was conducted. RESULTS: After 2 and 4 weeks of treatment, except the scores for hypnotic drug in the two groups and sleep disorder after 2 weeks of treatment in the control group, the scores of the other factors and the total scores of PSQI were all reduced when compared with those before treatment in the two groups (P<0.05). After 4 weeks of treatment, except the scores for hypnotic drug in the two groups and sleep disorder in the control group, the scores of the other factors and the total scores of PSQI were lower than those after 2 weeks of treatment in the two groups (P<0.05). After 2 weeks of treatment, the scores for time to fall asleep, sleep efficiency and daytime dysfunction in the observation group were lower than those of the control group (P<0.05); and after 4 weeks of treatment, except the scores for sleep disorder and hypnotic drug, the scores of the other factors and the total score of PSQI in the observation group were all lower than those of the control group (P<0.05). After 2 and 4 weeks of treatment, ISI scores and the scores of TCM symptom scale decreased when compared with those before treatment (P<0.05), and the scores of these two scales after 4 weeks of treatment were lower than those after 2 weeks of treatment (P<0.05) in the two groups; and the scores in the observation group were lower than thoese in the control group (P<0.05). The total effective rate was 93.3% (28/30) in the observation group, higher than that (90.3% [28/31]) in the control group (P<0.05). Of 64 cases, there was only 1 case of mild hematoma in the control group; and no any other adverse events occurred. Among 64 cases, the meridians, with the imbalance frequency ≥30 times, included the pericardium meridian of hand-jueyin and the heart meridian of hand-shaoyin; those with the imbalance frequency ≥20 times, were the kidney meridian of foot-shaoyin, the triple energizers meridian of hand-shaoyang, the gallbladder meridian of foot-shaoyang, the spleen meridian of foot-taiyin and the stomach meridian of foot-yangming. Except the lung meridian of hand-taiyin in the control group, the imbalance value of each meridian was reduced after treatment (P<0.05, P<0.001, P<0.01), and the meridian imbalance value presented a linear positive correlation with the total score of PSQI in the two groups . CONCLUSION: Meridian differentiation acupuncture based on detecting the specific response of jing-well point can significantly improve the sleep quality and reduce the related symptoms in the patients with intractable insomnia. This therapy promotes the conversion of the meridians from the imbalance to the balance and is satisfactory in its safe operation. 目的：评价基于井穴特异性反应检测的辨经针刺治疗顽固性失眠的临床疗效及安全性。方法：将64例顽固性失眠患者随机分为观察组（32例，脱落1例，剔除1例）和对照组（32例，剔除1例）。观察组以井穴检测的经脉失衡值为依据针刺相应原穴及背俞穴；对照组取百会、四神聪及双侧神门、三阴交、申脉、照海行常规针刺，并予井穴检测进行盲法处理。两组均每日1次，每周治疗5次，连续治疗4周。于治疗前及治疗2、4周后，观察两组匹兹堡睡眠质量指数量表（PSQI）、失眠严重程度指数量表（ISI）、中医症状量表评分，并于治疗后评定两组临床疗效和安全性；观察两组患者治疗前后经脉失衡值，并与PSQI总分进行相关性分析。结果：治疗2、4周后，除催眠药物因子与对照组治疗2周后睡眠障碍因子外，两组患者PSQI各因子评分及总分均较治疗前降低（P<0.05）；治疗4周后，除催眠药物因子及对照组睡眠障碍因子外，两组患者PSQI各因子评分及总分均低于治疗2周后（P<0.05）。治疗2周后，观察组患者入睡时间、睡眠效率、日间功能障碍因子评分低于对照组（P<0.05）；治疗4周后，除睡眠障碍及催眠药物因子外，观察组患者PSQI各因子评分和总分均低于对照组（P<0.05）。治疗2、4周后，两组患者ISI评分及中医症状量表评分均治疗前降低（P<0.05），且观察组均低于对照组（P<0.05）；治疗4周后两组患者两项评分均低于治疗2周后（P<0.05）。观察组总有效率为93.3%（28/30），高于对照组的90.3%（28/31，P<0.05）。64例患者仅对照组出现1例轻微血肿，其余无不良事件发生。64例患者经脉失衡频次≥30次的经脉为手厥阴心包经和手少阴心经，经脉失衡频次≥20次的经脉为足少阴肾经、手少阳三焦经、足少阳胆经、足太阴脾经、足阳明胃经；除对照组手太阴肺经外，两组患者治疗后各经脉失衡值均降低（P<0.05，P<0.001，P<0.01）。两组经脉失衡值与PSQI评分均呈线性正相关。结论：基于井穴特异性反应检测的辨经针刺能显著降低顽固性失眠患者的睡眠质量及相关症状，促进患者经脉状态由失衡转向平衡，安全性较好。.

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