Acupuncture improves sleep for insomnia sufferers, especially when combined with tuina massage. Hospital researchers examined 80 insomnia patients in two groups. All patients admitted to the study had insomnia and the traditional Chinese medicine (TCM) differential diagnosis of spleen and stomach disharmony. Patients receiving acupuncture monotherapy had a 72.5% total effective rate and patients receiving both tuina massage and acupuncture had a 92.5% total effective rate (p<0.05).
Patients were randomly assigned to the acupuncture monotherapy or the combined therapy group. The monotherapy group was comprised of 21 male and 19 female patients, ages 26–69 years (mean age 51.4 years), with a disease duration of 1–6 years (mean duration 3.3 years). The combined therapy group was comprised of 20 male and 20 female patients, ages 27–70 years (mean age 51.7 years), with a disease duration of 2–6 years (mean duration 3.4 years). There were no statistically significant differences in baseline characteristics between the two groups at the initiation of the investigation (p>0.05).
Acupuncture And Tuina
Both groups received acupuncture treatment administered at the following acupoints:
- Shenmai (BL62)
- Anmian (MHN54)
- Zhaohai (KD6)
- Baihui (GV20)
- Fengchi (GB20)
- Yintang (MHN3)
- Shenting (GV24)
The acupoints Shenmai, Baihui, and Zhaohai received 0.25 x 25 mm needles, using a slow twisting-rotating action. Needles were inserted to a depth of 13–20 mm and were retained for 30 minutes. The remaining acupoints were inserted in a conventional fashion. In addition to the above, patients assigned to the combined therapy group received acupuncture treatment at Zusanli (ST36), which was stimulated using a twisting-rotating reinforcing method. These patients also received tuina massage, administered according to the following protocol:
Firm pressure was applied using a single finger, from Yintang to Shenting, repeated 7 times. Both hands were used to lightly stroke from Yintang across the eye sockets, repeated 7 times. A single finger was used to apply pressure to Yuyao (MHN6), Yintang, Shenting, Taiyang (MHN9), and Baihui. Pressure was applied to each point for 2 minutes in total.
Both hands were used to sweep across both sides of the head, repeated 30 times. Na fa (grasping technique) was used to stimulate Jianjing (GB21), Fengchi, and the Wujing (five meridian) regions located on the inner finger tips. Each point was stimulated for 3 minutes in total. Each patient was then guided to a supine position and the abdomen was massaged using mo fa (palm rubbing technique), first in a clockwise and then counter-clockwise direction for 3 minutes. Finger pressure was then applied to Qihai (CV6), Zhongwan (CV12), and Guanyuan (CV4) for 2 minutes each.
The patient was moved to a prone position and gun fa (rolling technique) was used to massage over Pishu (BL20), Ganshu (BL18), Mingmen (GV4), and Shenshu (BL23) for 5 minutes each. Finally, tui fa (palm pushing technique) was used to massage along the spine to the caudal vertebrae, repeated 7 times. Each course of treatment lasted one week, and a total of three courses were administered.
Overall, the authors and researchers at the Healthcare Medicine Institute find the protocols sufficient to warrant conclusions with the caveat that the addition of needling ST36 in the combined therapy group introduces an additional variable. Outcome measures for the study included the PSQI (Pittsburgh Sleep Quality Index) and improvements in sleep duration and quality. The PSQI is a 7-item scale rating sleep symptoms, including subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, and medication use. Each item is rated from 0–3, with higher scores indicative of more severe sleep disturbances.
Mean pre-treatment PSQI scores were 15.5 in the acupuncture monotherapy group and 15.9 in the combined therapy group. Following treatment, scores were reduced to 7.9 and 5.4 respectively. Both groups experienced improvements, but these were significantly greater in the combined therapy group (p<0.05). To calculate improvements in sleep duration and quality, the following criteria were applied:
- Patients experiencing >6 hours of deep sleep per night and sufficient daytime energy, with improvements maintained for >5 months, were classified as recovered.
- For patients experiencing 4–6 hours of sleep per night, with improved deep sleep and daytime energy, the treatment was classified as markedly effective.
- For patients experiencing improved symptoms, but whose sleep duration was still <3 hours, the treatment was classified as effective.
- For patients experiencing no improvement in symptoms, the treatment was classified as ineffective.
The recovered, markedly effective, and effective rates were added together to calculate the total improvement rate. In the acupuncture monotherapy group, there were 7 recovered, 10 markedly effective, 12 effective, and 11 ineffective cases, yielding a total improvement rate of 72.5%. In the combined therapy group, there were 12 recovered, 15 markedly effective, 10 effective, and 3 ineffective cases, yielding a total improvement rate of 92.5%. Improvements were significantly greater in the combined therapy group (p<0.05). The outcomes of this study indicate that acupuncture provides an effective treatment for insomnia and its effects can be greatly enhanced by the addition of tuina massage.
Wang Zhihua (2019) “Clinical observation of acupuncture and massage in stomach and spleen disharmony insomnia” China’s Naturopathy Vol. 27(3) pp. 21-22.