Objective: To observe the clinical efficacy of acupuncture combined with bamboo-based medicinal moxibustion in the treatment of chronic insomnia complicated with mild depressive state.
Methods: A total of 60 patients with chronic insomnia complicated with mild depressive state were randomly divided into an observation group and a control group, 30 cases in each group. The control group was treated with acupuncture at bilateral Zhaohai (KI6), Shenmen (HT7), Sanyinjiao (SP6), Anmian (Extra) and Sishencong (EX-HN1), Baihui (GV20), etc. The observation group was treated with bamboo-based medicinal moxibustion based on the treatment in the control group, on the abdomen，Shenque (CV8), Guanyuan (CV4), Zhongwan (CV12) and bilateral Tianshu (ST25) were selected , on the back, the acupoints of governer vessel from Dazhui (GV14) to Yaoshu (GV2) were selected. Both groups were treated once every other day, 3 times a week for 4 weeks. The Pittsburgh sleep quality index (PSQI) score, Hamilton depression scale-17 (HAMD-17) score, insomnia severity index (ISI) score, fatigue assessment instrument (FAI) score before and after treatment and after 2 weeks of treatment completion (follow-up) were observed in the two groups, and the serum level of γ-aminobutyric acid (GABA) before and after treatment was detected in the two groups, and the clinical efficacy and safety were evaluated.
Results: After treatment and in the follow-up, the sub-item scores and total scores of PSQI in both groups were reduced compared with those before treatment (P<0.001); except for the score of daytime dysfunction in the follow-up, the scores of sleep quality, sleep duration, daytime dysfunction, and total scores of PSQI in the observation group were lower than those in the control group (P<0.05). After treatment and in the follow-up, the HAMD-17, ISI and FAI scores in both groups were reduced compared with those before treatment (P<0.001); the scores in the observation group were lower than those in the control group (P<0.05). After treatment，the serum levels of GABA in both groups were increased compared with those before treatment (P<0.05); the level in the observation group was higher than that in the control group (P<0.05). The total effective rate of treating chronic insomnia in the observation group was 96.7% (29/30), which was higher than 80.0% (24/30) in the control group (P<0.05); and the total effective rate of improving mild depressive state was 93.3% (28/30), which was higher than 66.7% (20/30) in the control group (P<0.001). During the treatment period, no serious adverse reactions occurred in both groups.
Conclusion: Acupuncture combined with bamboo-based medicinal moxibustion has definite efficacy in the treatment of chronic insomnia complicated with mild depressive state, and has synergistic efficacy in improving sleep quality, sleep duration, daytime dysfunction and depressive state, its action mechanism may be related to the increase of serum level of GABA.
目的：观察针刺联合竹技药灸法治疗慢性失眠伴轻度抑郁状态的疗效。方法：将60例慢性失眠伴轻度抑郁状态患者随机分为观察组和对照组，每组30例。对照组予针刺治疗，穴取双侧照海、神门、三阴交、安眠及四神聪、百会等；观察组在对照组治疗基础上联合竹技药灸法，腹部穴取神阙、关元、中脘及双侧天枢，背部穴取督脉大椎至腰俞段。两组均隔日治疗1次，每周3次，共治疗4周。比较两组患者治疗前后及治疗结束后2周（随访）匹兹堡睡眠质量指数（PSQI）、汉密尔顿抑郁量表17项（HAMD-17）、失眠严重指数（ISI）和疲劳评定量表（FAI）评分，检测两组患者治疗前后血清γ-氨基丁酸（GABA）含量，并评定临床疗效和安全性。结果：治疗后及随访时，两组患者PSQI各项评分及总分均较治疗前降低（P<0.001）；除随访时日间功能障碍评分外，观察组患者PSQI睡眠质量、睡眠时间、日间功能障碍评分及总分低于对照组（P<0.05）。治疗后及随访时，两组患者HAMD-17、ISI、FAI评分均较治疗前降低（P<0.001），且观察组低于对照组（P<0.05）。治疗后，两组患者血清GABA含量均较治疗前升高（P<0.05），且观察组高于对照组（P<0.05）。观察组改善慢性失眠的总有效率为96.7%（29/30），高于对照组的80.0%（24/30，P<0.05）；改善轻度抑郁状态的总有效率为93.3%（28/30），高于对照组的66.7%（20/30，P<0.001）。治疗期间，两组患者均未发生严重不良反应。结论：针刺联合竹技药灸法治疗慢性失眠伴轻度抑郁状态疗效肯定，两种疗法在改善患者的睡眠质量、睡眠时间、日间功能障碍及抑郁状态方面具有增效性，其作用机制可能与升高患者血清GABA含量相关。.
Keywords: acupuncture; bamboo-based medicinal moxibustion; chronic insomnia; depression; randomized controlled trial (RCT).