Acupuncture and herbs alleviate insomnia. Wenzhou Central Hospital and First Affiliated Hospital of Wenzhou Medical University researchers conclude that acupuncture plus the herbal formula Jiao Tai Wan improves sleep and reduces inflammatory biomarkers. [1] The inclusion of inflammatory biomarkers as an outcome measure is of special interest since insufficient sleep has been linked with an increased risk of systemic inflammation and associated health risks.

Outcome measures included the PSQI (Pittsburgh Sleep Quality Index) and inflammatory biomarkers, including TNF-α (tumor necrosis factor-alpha), IL-6 (interleukin-6), and IL-1β (interleukin-1 beta). Two groups were compared. Control group one received Jiao Tai Wan and usual care consisting of sleep hygiene advice (including maintaining a comfortable bedroom environment and a positive attitude, avoiding smoking, alcohol, and caffeine before bed, engaging in daily exercise, and eating an appropriate evening meal).

Group two received identical usual care and herbal medicine plus the addition of acupuncture. Both groups demonstrated significant improvements following treatment, but improvements were significantly greater in the acupuncture group, which had a total effective rate of 90%, compared with 66.67% in the control group. The results indicate that acupuncture improves outcomes for patients with insomnia.

 

Investigation
A total of 60 patients with insomnia due to disharmony of the heart and kidneys were assigned by randomization through a digital table to an acupuncture group or a control group. The acupuncture group was comprised of 13 male and 17 female patients, ages 28–60 years (mean age 43.37 years), with a duration of disease between 6 months and 10 years (mean duration 41.33 months). The control group was comprised of 14 male and 16 female patients, ages 25–60 years (mean age 42.87 years), with a duration of disease between 6 months and 9 years (mean duration 48.03 months). There were no statistically significant differences in baseline characteristics between the two groups (p>0.05).

Biomedical diagnostic criteria included one or more of the following symptoms: difficulty falling asleep (sleep latency of >30 minutes), sleep maintenance disorder (waking twice or more during the night), waking early, poor sleep quality or duration (<6 hours), and waking unrefreshed. Symptoms were required to be present even when sleeping under suitable conditions and combined with daytime functional impairments, including: fatigue, reduced attention or memory, impaired educational, occupational, or social function, anxiety, irritability, daytime somnolence, lack of interest or energy, increased risk of errors or accidents, nervousness, headaches, or other physical symptoms associated with insufficient sleep.

TCM (Traditional Chinese Medicine) diagnostic criteria included the following: sleeplessness due to disharmony of the heart and kidneys, difficulty falling asleep or maintaining sleep, waking easily, difficulty falling back to sleep after waking, dizziness, headaches, tinnitus, exhaustion, knee or lumbar pain, irritability, depression, nocturnal emissions, night sweats, a red tongue, or a rapid-fine pulse.

In addition to meeting the above diagnostic criteria, patients were required to be ages 18–60 years and provide consent to participate in the study. Exclusion criteria included concurrent comorbidities or treatments that might interfere with the study outcomes, pregnancy or lactation, allergies to the herbs used in the study, and serious heart, liver, or kidney dysfunction that may interfere with the metabolism of herbs.

 

Acupuncture And Herbs
All patients received usual care, which was comprised of sleep hygiene advice such as keeping a comfortable bedroom environment, maintaining a positive attitude, avoiding smoking, alcohol, and caffeine before bed, taking daily exercise, and eating an appropriate evening meal. In addition to this, all patients were prescribed Jiao Tai Wan herbal formula comprised of Huang Lian and Rou Gui in a 10:1 ratio. The herbs were ground to powder and were used to fill gelatin capsules containing 0.4 grams of total herbs each in each capsule. The dosage was 4 capsules, taken twice daily (at 4 pm and 9 pm) with warm water, for a total of 4 weeks. Patients assigned to the acupuncture group also received acupuncture treatment administered at the following acupoints:

  • Anmian (NHN54)
  • Xinshu (BL15)
  • Shenshu (BL23)
  • Shenmen (HT7)
  • Zhaohai (KD6)

Patients were treated in a prone position using 0.30 × 40 mm filiform needles. Following disinfection with 75% ethanol, needles were inserted rapidly to the following angles and depths:

  • Anmian: perpendicular, 0.5–1 cun
  • Xinshu: oblique toward midline, 0.5–0.8 cun
  • Shenshu: perpendicular, 0.8 –1 cun
  • Shenmen: perpendicular, 0.3–0.4 cun
  • Zhaohai: perpendicular, 0.5–0.8 cun

Following insertion, all needles were stimulated by lifting, thrusting, twisting, and rotation. After eliciting deqi, needles were retained for 30 minutes and were rotated once every 10 minutes. Treatment was administered daily, 5 days a week, with 4 weeks making up one course of treatment.

 

Results
Outcome measures included the PSQI, TNF-α, IL-6, IL-1β, and the treatment total effective rate. The PSQI is a self-rated questionnaire comprised of 19 individual items in areas of sleep quality, latency, duration, efficiency, disturbances, uses of medications, and daytime dysfunction. Each area is rated on a scale of 0–3, giving a maximum possible score of 21, with higher scores indicative of more severe insomnia. Mean pre-treatment PSQI scores were 14.43 in the acupuncture group and 14.03 in the control group. Following treatment, scores fell to 7.70 and 8.97 respectively, showing significantly greater improvements in the acupuncture group (p<0.05).

The inflammatory markers TNF-α, IL-6, and IL-1β were measured by taking a fasting sample of venous blood and centrifuging it at 3000 r/min for 15 minutes. In the acupuncture group, mean pre-treatment TNF-α was 8.71 pg/mL, IL-6 was 7.46P g/mL, and IL-1β was 6.64 pg/mL. In the control group, measurements were 8.68 pg/mL, 7.48P g/mL, and 6.67 pg/mL respectively. Following treatment, measurements fell to 3.83 pg/mL, 2.76 pg/mL, and 2.70 pg/mL in the acupuncture group and 4.23 pg/mL, 3.57 pg/mL, and 3.61 pg/mL in the control group. Improvements were significantly greater in the acupuncture group (p<0.05).

The treatment total effective rate was calculated for the two groups. Patients with a post-treatment PSQI score of <7 and a resolution of symptoms were classified as recovered. In patients showing PSQI score reductions of 50–75% and clear improvements in symptoms, the treatment was classified as markedly effective. In patients showing PSQI score reductions of 20–50% and some improvements in symptoms, the treatment was classified as markedly effective. In patients showing <25% reductions in PSQI scores and no change in symptoms, the treatment was classified as ineffective. The recovered, markedly effective, and effective cases were added together to give the total effective rate.

In the acupuncture group, there were 8 recovered, 7 markedly effective, 12 effective, and 3 ineffective cases, giving a total effective rate of 90%. In the control group, there were 5 recovered, 5 markedly effective, 10 effective, and 10 ineffective cases, giving a total effective rate of 66.67%. The difference in efficacy between the two groups was statistically significant (p<0.05). The results of this study indicate that acupuncture relieves the symptoms of insomnia as well as having the potential to reduce associated inflammation.

 

Reference:
Qian Lala, Zhang Hong, Weng Jinyue, Yuan Zhengzhong (2019) “Effects of Combination of Jiao Tai Pill with Acupuncture on Disharmony of Heart and Kidney Insomnia and Its Influence on TNF-α, IL-6 and IL -1β” Chinese Archives of Traditional Chinese Medicine Vol.37 (3) pp.525-527.

 

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