调任通督法针刺与疏肝解郁汤在失眠伴焦虑症中的应用

doi:10.3760/cma.j.cn441417-20241106-14031

国际医药卫生导报 ›› 2025, Vol. 31 ›› Issue (14): 2443-2449.DOI: 10.3760/cma.j.cn441417-20241106-14031

调任通督法针刺与疏肝解郁汤在失眠伴焦虑症中的应用

梁丹¹ 陈静¹ 李敏² 高萌桧³ 张亚萍¹ 张明月¹ 陈景平⁴

¹汉中市中医医院脑病·肿瘤科，汉中 723102；²汉中市中医医院医务质控科，汉中 723102；³汉中市中医医院消毒供应室，汉中 723102；⁴汉中市中医医院脑病科，汉中 723102

收稿日期:2024-11-06 出版日期:2025-07-01 发布日期:2025-08-06
通讯作者: 张明月，Email：mingyue89416@126.com
基金资助:
陕西省中医药管理局科研项目（SZY-NLTL-2022-028）

Tiaoren Tongdu acupuncture combined with Shugan Jieyu decoction for patients with insomnia and anxiety disorder

Liang Dan¹, Chen Jing¹, Li Min², Gao Menghui³, Zhang Yaping¹, Zhang Mingyue¹, Chen Jingping⁴

¹Department of Neurology and Oncology, Hanzhong Hospital of Traditional Chinese Medicine, Hanzhong 723102, China; ²Medical Quality Control Department, Hanzhong Hospital of Traditional Chinese Medicine, Hanzhong 723102, China; ³Disinfection Supply Room, Hanzhong Hospital of Traditional Chinese Medicine, Hanzhong 723102, China; ⁴Department of Brain Diseases, Hanzhong Hospital of Traditional Chinese Medicine, Hanzhong 723102, China

Received:2024-11-06 Online:2025-07-01 Published:2025-08-06
Contact: Zhang Mingyue, Email: mingyue89416@126.com
Supported by:
Scientific Research Project of Shaanxi Administration of Traditional Chinese Medicine (SZY-NLTL-2022-028)

摘要/Abstract

摘要：

目的　探讨调任通督法针刺与疏肝解郁汤在失眠伴焦虑症中的应用效果。方法　采用前瞻性随机对照试验。选取2021年1月至2024年6月汉中市中医医院168例失眠伴焦虑症（心肾不交证）患者，随机数字表法分为A、B、C、D组，各42例。A组男18例、女24例，年龄（55.12±9.63）岁，焦虑症病程22（14，31）个月，失眠病程34（20，48）个月；B组男16例、女26例，年龄（56.55±10.98）岁，焦虑症病程25（14，33）个月，失眠病程36（21，50）个月；C组男15例、女27例，年龄（54.64±9.27）岁，焦虑症病程24（12，32）个月，失眠病程34（21，51）个月；D组男16例、女26例，年龄（54.83±10.02）岁，焦虑症病程23（15，30）个月，失眠病程32（20，47）个月。A组采用常规西医治疗，B组采用常规西医联合疏肝解郁汤治疗，C组采用常规西医联合调任通督法针刺治疗，D组采用常规西医、调任通督法针刺联合疏肝解郁汤治疗。比较各组治疗前后中医症状评分、汉密尔顿焦虑量表（HAMA）评分、匹兹堡睡眠质量指数（PSQI）评分、血清5-羟色胺（5-HT）、去甲肾上腺素（NE）、多巴胺（DA）水平；统计各组临床疗效及不良反应。采用χ²检验、秩和检验、t检验、单因素方差分析、SNK-q检验、Kruskal-Wallis H和Mann-Whitney U检验进行统计分析。结果　共排除6例患者，纳入162例，包括A组39例，B组41例，C组40例，D组42例。治疗后，A组中医症状主症评分、次症评分、舌脉象评分、总分、HAMA评分、PSQI评分和血清5-HT、NE、DA水平分别为（7.92±1.25）分、（7.38±1.17）分、2（0，2）分、（16.36±3.36）分、（9.62±1.42）分、（8.33±1.54）分、（133.06±18.74）g/L、（25.31±4.82）μg/L、（394.49±72.32）mmol/L，B组分别为（7.02±1.06）分、（6.80±1.06）分、1（0，2）分、（14.80±2.81）分、（8.76±1.31）分、（7.37±1.41）分、（145.11±20.36）g/L、（19.99±3.96）μg/L、（343.19±59.63）mmol/L，C组分别为（6.95±1.03）分、（6.70±1.01）分、1（0，2）分、（14.60±2.75）分、（8.53±1.27）分、（7.45±1.36）分、（148.13±20.17）g/L、（20.05±4.03）μg/L、（340.13±58.49）mmol/L，D组分别为（5.83±0.98）分、（5.74±0.96）分、0（0，1）分、（12.38±2.44）分、（7.02±1.12）分、（6.79±1.24）分、（162.74±22.55）g/L、（15.98±3.36）μg/L、（318.53±50.17）mmol/L；治疗后各组中医症状主症评分、次症评分、舌脉象评分、总分及HAMA评分、PSQI评分和血清NE、DA水平均低于治疗前，B、C、D组低于A组（均P<0.05），D组低于B、C组（均P<0.05）；血清5-HT水平高于治疗前，B、C、D组高于A组（均P<0.05），D组高于B、C组（均P<0.05）。A、B、C、D组总有效率分别为76.92%（30/39）、85.37%（35/41）、87.50%（35/40）、97.62%（41/42），D组总有效率高于A组（P<0.05）；A、B、C、D组不良反应总发生率比较，差异无统计学意义（P>0.05）。结论　在常规西医基础上应用调任通督法针刺与疏肝解郁汤治疗失眠伴焦虑症（心肾不交证）均可缓解症状，减轻焦虑情绪，改善睡眠质量，调节血清神经递质水平。

关键词: 失眠, 焦虑症, 调任通督法针刺, 疏肝解郁汤, 神经递质

Abstract:

Objective　To explore the effect of Tiaoren Tongdu acupuncture combined with Shugan Jieyu decoction for patients with insomnia and anxiety disorder. Methods　A total of 168 patients with insomnia and anxiety disorder (heart kidney disharmony) treated at Hanzhong Hospital of Traditional Chinese Medicine from January 2021 to June 2024 were selected for the randomized controlled trial, and were divided into groups A, B, C, and D by the random number table method, with 42 cases in each group. In group A, there were 18 males and 24 females; they were (55.12±9.63) years old; the duration of anxiety disorder was 22 (14, 31) months; the duration of insomnia was 34 (20, 48) months. In group B, there were 16 males and 26 females; they were (56.55±10.98) years old; the duration of anxiety disorder was 25 (14, 33) months; the duration of insomnia was 36 (21, 50) months. In group C, there were 15 males and 27 females; they were (54.64±9.27) years old; the duration of anxiety disorder was 24 (12, 32) months; the duration of insomnia was 34 (21, 51) months. In group D, there were 16 males and 26 females; they were (54.83±10.02) years old; the duration of anxiety disorder was 23 (15, 30) months; the duration of insomnia was 32 (20, 47) months. Group A were treated with conventional western medicine, group B with conventional western medicine and Shugan Jieyu decoction, group C with conventional western medicine and Tiaoren Tongdu acupuncture, and group D with conventional western medicine, Tiaoren Tongdu acupuncture, and Shugan Jieyu decoction. The scores of traditional Chinese medicine symptoms, Hamilton Anxiety Scale (HAMA), and Pittsburgh Sleep Quality Index (PSQI) and serum levels of 5-hydroxytryptamine (5-HT), norepinephrine (NE), and dopamine (DA) before and after the treatment, clinical efficacies, and occurrence of adverse reactions were compared between the two groups. Statistical analyses were performed using the χ² test, rank sum test, t test, one-way analysis of variance, SNK-q test, Kruskal-Wallis H test, and Mann-Whitney U test. Results　Six cases were excluded, and 162 were included, including 39 in group A, 41 in group B, 40 in group C, and 42 in group D. After the treatment, the scores of traditional Chinese medicine main symptoms, secondary symptoms, and tongue and pulse, total score of traditional Chinese medicine symptoms, scores of HAMA and PSQI, and serum levels of 5-HT, NE, and DA in group A were 7.92±1.25, 7.38±1.17 points, 2 (0, 2), 16.36±3.36, 9.62±1.42, 8.33±1.54, (133.06±18.74) g/L, (25.31±4.82) μg/L, and (394.49±72.32) mmol/L; those in group B were 7.02±1.06, 6.80±1.06, 1 (0, 2), 14.80±2.81, 8.76±1.31, 7.37±1.41, (145.11±20.36) g/L, (19.99±3.96) μg/L, and (343.19±59.63) mmol/L; those in group C were 6.95±1.03, 6.70±1.01, 1(0, 2), 14.60±2.75, 8.53±1.27, 7.45±1.36, (148.13±20.17) g/L, (20.05±4.03) μg/L, and (340.13±58.49) mmol/L; those in group D were 5.83±0.98, 5.74±0.96, 0(0, 1), 12.38±2.44, 7.02±1.12, 6.79±1.24, (162.74±22.55) g/L, (15.98±3.36) μg/L, and (318.53±50.17) mmol/L; after the treatment, the traditional Chinese medicine main symptom score, secondary symptom score, tongue and pulse score, total score, HAMA score, PSQI score, and serum levels of NE and DA were lower than those before the treatment in all the groups; those in groups B,C, and D were higher than those in group A (all P<0.05); those in group D were higher than those in groups B and C (all P<0.05). The total effective rates of groups A, B, C, and D were 76.92% (30/39), 85.37% (35/41), 87.50% (35/40), and 97.62% (41/42), respectively, and the total effective rate of group D was higher than that of group A (P<0.05). There was no statistical difference in the total incidence rate of adverse reactions between the 4 groups (P>0.05). Conclusion　On the basis of conventional western medicine, the effect and safety of applying Tiaoren Tongdu acupuncture and Shugan Jieyu decoction in the treatment of patients with insomnia and anxiety disorder (heart kidney disharmony) can relieve their symptoms and anxiety, improve their sleep quality, and regulate the serum levels of neurotransmitters.

Key words: Insomnia, , Anxiety disorder, , Tiaoren Tongdu , acupuncture, , Shugan Jieyu , decoction, , Neurotransmitters

梁丹陈静李敏高萌桧张亚萍张明月陈景平.

调任通督法针刺与疏肝解郁汤在失眠伴焦虑症中的应用 [J]. 国际医药卫生导报, 2025, 31(14): 2443-2449.

Liang Dan, Chen Jing, Li Min, Gao Menghui, Zhang Yaping, Zhang Mingyue, Chen Jingping.

Tiaoren Tongdu acupuncture combined with Shugan Jieyu decoction for patients with insomnia and anxiety disorder [J]. International Medicine and Health Guidance News, 2025, 31(14): 2443-2449.

参考文献

[1]Paul AM, Salas RE. Insomnia[J]. Prim Care, 2024, 51(2): 299-310. DOI:10.1016/j.pop.2024.02.002.

[2]何静文,苏彤,唐云翔.关注睡眠,关爱健康:«中国睡眠研究报告2023»解读[J].海军军医大学学报, 2023, 44(11): 1261-1267. DOI:10.16781/j.CN31-2187/R.20230211.

[3]Wołyńczyk-Gmaj D, Jakubczyk A, Trucco EM, et al. Emotional dysregulation, anxiety symptoms and insomnia in individuals with alcohol use disorder[J]. Int J Environ Res Public Health, 2022, 19(5): 2700-2708. DOI:10.3390/ijerph19052700.

[4]Shinalieva K, Kasenova A, Akhmetzhanova Z, et al. Association of insomnia with anxiety and depression in type 2 diabetic patients: a cross-sectional study[J]. Iran J Med Sci, 2023, 48(5): 448-455. DOI:10.30476/ijms.2023.96017.2755.

[5]邱一吾,赵青青,王雪姗,等.基于"肾藏精,精舍志"探讨从肾论治不寐病[J].浙江中医药大学学报, 2023, 47(8): 857-862. DOI:10.16466/j.issn1005-5509.2023.08.004.

[6]顾玲.通督调任针刺法治疗失眠的临床研究[D].合肥:安徽中医药大学, 2023.

[7]张堃,周楠,王立娜.补泻针灸疗法联合疏肝解郁汤治疗原发性干燥综合征伴焦虑抑郁临床研究[J].陕西中医, 2022, 43(4): 515-518. DOI:10.3969/j.issn.1000-7369.2022.04.027.

[8]中华医学会神经病学分会,中华医学会神经病学分会睡眠障碍学组.中国成人失眠诊断与治疗指南(2017版)[J].中华神经科杂志, 2018, 51(5): 324-335. DOI:10.3760/cma.j.issn.1006-7876.2018.05.002.

[9]中华医学会精神病学分会.中国精神障碍分类与诊断标准第三版(精神障碍分类)[J].中华精神科杂志, 2001, 34(3): 184-188. DOI:10.3760/j:issn:1006-7884.2001.03.028.

[10]周仲瑛.中医内科学[M]. 2版.北京:中国中医药出版社, 2007: 149-153.

[11]国家药品监督管理局.中药新药临床研究指导原则[M].北京:中国医药科技出版社, 2002: 124.

[12]Liu F, Hu X, Zhu XL, et al. A community-based cross-sectional study of anxiety and metabolic syndrome[J]. Psychogeriatrics, 2023, 23(3): 450-457. DOI:10.1111/psyg.12953.

[13]Zitser J, Allen IE, Falgàs N, et al. Pittsburgh sleep quality index (PSQI) responses are modulated by total sleep time and wake after sleep onset in healthy older adults[J]. PLoS One, 2022, 17(6): 1003-1010. DOI:10.1371/journal.pone.0270095.

[14]国家中医药管理局.中医病症诊断疗效标准[M].南京:南京大学出版社, 1994: 45.

[15]Akram U, Stevenson J. Altered emotion perception in insomnia, anxiety, depression, mania, psychotic experiences and schizotypal symptoms: a dataset[J]. Sci Data, 2024, 11(1): 990-998. DOI:10.1038/s41597-024-03736-9.

[16]张林涛,王瑾,陈杰,等.调心安神针刺法联合认知行为疗法对慢性失眠症患者的影响[J].国际医药卫生导报, 2024, 30(13): 2225-2229. DOI:10.3760/cma.j.issn.1007-1245.2024.13.021.

[17]倪洁泓,张谦.基于数据挖掘的叶天士治疗不寐用药规律分析[J].浙江中西医结合杂志, 2022, 32(12): 1147-1150. DOI:10.3969/j.issn.1005-4561.2022.12.020.

[18]陈润铭,韩振蕴,胡文悦,等.庞鹤基于"神安则寐,神不安则不寐"治疗不寐经验[J].现代中医临床, 2024, 31(4): 70-73,94. DOI:10.3969/j.issn.2095-6606.2024.04.013.

[19]王荣荣. «杂病源流犀烛»对仲景学说杂病学术思想的传承与发展[D].济南:山东中医药大学, 2023.

[20]陈冬真,虢周科,王建军,等.虢周科教授治疗失眠伴焦虑状态临床经验[J].陕西中医, 2022, 43(8): 1095-1098. DOI:10.3969/j.issn.1000-7369.2022.08.026.

[21]王宏雅,武晓玉,刘惠萍,等.以防治大鼠失眠焦虑心肾不交证量效优选交泰丸制备工艺[J].中国药师, 2021, 24(7): 292-296,309. DOI:10.19962/j.cnki.issn1008-049X.2021.07.015.

[22]卓缘圆,张金文,郭悦宝,等.杨卓欣教授"调任通督"针刺法的理论内涵和应用[J].上海针灸杂志, 2019, 38(1): 97-100. DOI:10.13460/j.issn.1005-0957.2019.01.0097.

[23]李虎成,高齐,李永宏.针刺督脉穴治疗失眠的疗效观察及对患者血清神经递质水平的影响[J].上海针灸杂志, 2023, 42(10): 1030-1035. DOI:10.13460/j.issn.1005-0957.2023.10.1030.

[24]白薇,王炳然,刘琪,等.调神为主针刺联合穴位贴敷对老年失眠患者的影响[J].光明中医, 2024, 39(9): 1827-1829. DOI:10.3969/j.issn.1003-8914.2024.09.041.

[25]张鸿雁,魏崇,马琦,等.从"心与胆通"理论治疗焦虑性失眠探析[J].湖北中医药大学学报, 2022, 24(6): 56-59. DOI:10.3969/j.issn.1008-987x.2022.06.14.

[26]吴毅星,李芷娴,杨粤戈,等.从脾郁气结论治焦虑失眠症的思路探讨[J].广州中医药大学学报, 2023, 40(8): 2074-2079. DOI:10.13359/j.cnki.gzxbtcm.2023.08.034.

[27]梁雨璐,张洁,李忆红,等.整合网络毒理学和网络药理学的合欢皮抗焦虑毒效机制探究[J].药物评价研究, 2021, 44(7): 1411-1424. DOI:10.7501/j.issn.1674-6376.2021.07.008.

[28]Wang J, Tian E, Zhang YJ, et al. The effects of unilateral labyrinthectomy on monoamine neurotransmitters in the medial vestibular nucleus of rats[J]. Biomolecules, 2023, 13(11): 1637-1643. DOI:10.3390/biom13111637.

[29]崔长乐.基于现代文献的十二募穴知识图谱、证治规律及应用标准化研究[D].沈阳:辽宁中医药大学, 2022.DOI:10.27213/d.cnki.glnzc.2022.000047.

[30]芦玥,贾跃进,柴智,等.枢机安神汤对氯苯丙氨酸失眠大鼠神经递质和焦虑的影响[J].世界中医药, 2024, 19(2): 185-190. DOI:10.3969/j.issn.1673-7202.2024.02.008.

调任通督法针刺与疏肝解郁汤在失眠伴焦虑症中的应用

Tiaoren Tongdu acupuncture combined with Shugan Jieyu decoction for patients with insomnia and anxiety disorder

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