Insomnia is a subjective experience of sleep with its quality or amount insufficient to meet the physiological needs as a result of difficulties in sleep onset and/or sleep maintenance. It can influence the social functions. It is one of the most common sleep disorders [
Insomnia is the result of damage to the anatomical structure that controls the sleep and neurotransmitter transmission dysfunctions due to various causes [
In Mongolian medicine, insomnia is also called sleep uneasiness. It is a disease characterized by frequent loss of normal sleep as a result arising from disequilibrium of “Sangen” (Sangen are the basic conditions for survival and life activities of humans) and disorders of “body, heart, and speech” functions. Disequilibrium of “Sangen,” prevalence of “Haoyi” (Haoyi is classified into five categories, i.e., Siming Haoyi, Shangxing Haoyi, Puxing Haoyi, Tiaohuo Haoyi, and Xiaqing Haoyi. They exist in the main veins, parietal regions, hearts, stomachs, and anus), and dysfunctions are the basic causes of the disease. Negative moods such as tension, worry, fear, depression, and anxiety, and social environment, diet, daily life, movement, and so forth belong to external causes. Alleviating “Haoyi” and regulating equilibrium of “Sangen” are the main treatment principles [
The research involves the first clinical test of the efficacy of Mongolian medical warm acupuncture. The paper evaluates the role of Mongolian medical warm acupuncture in treating insomnia by investigating the Mongolian medicine syndromes and conditions, Pittsburgh sleep quality index, and polysomnography indexes.
The patients were diagnosed in accordance with Standards for Diagnosis and Efficacy of TCM Symptoms and International Classification of Sleep Disorders (ICSD-2) by US Sleep Research Society [
Inclusion criteria are as follows: (1) aged 20–75 years; (2) course of disease between 1 month and 2 years; (3) difficulty falling asleep and time for falling asleep was over 30 minutes; (4) sleep maintenance disorders, awakening times ≥ 2 overnight.
Criteria for exclusion are as follows: (1) pregnant women and women in the lactation period; (2) patients with serious disease or in the terminal stage of diseases; (3) patients with major depressive disorders (in accordance with Chinese Classification of Mental Disorders III (CCMD-3)) (depression can be divided into mild depression and major depression based on the degree of damage to the social functions. Depression can also be divided into depression without psychotic symptoms and depression with psychotic symptoms based on the presence or absence of psychotic symptoms such as illusion, delusion, and catatonic syndrome [
All cases used in the paper were hospitalized patients diagnosed as having insomnia in the Mongolian Department of the Affiliated Hospital of Inner Mongolia Medical University from September 2015 to December 2015. 80 cases were divided into 2 groups: Group 1, acupuncture group; Group 2, estazolam group using the stratified sampling random method in statistics. Each group was divided into three strata: mild, moderate, and severe based on the illness degree.
Warm acupuncture group: special silver needles were used for treatment. Acupoint selection: selection consisted of Dinghui Acupoint, Haoyi Acupoint, and Xin Acupoint. Dinghui Acupoint: it is at the intersection between the median line of the head and the line of the tips of ears. Haoyi Acupoint: it is at the center of the superior fovea of the first thoracic vertebrae. Xin Acupoint: it is at the center of the superior fovea of the seventh thoracic vertebrae. Needles: they are Mongolian silver needles (0.5 × 30 mm, Mongolian Medicine Clinical Apparatus Research Center, Inner Mongolia Medical University, Hohhot, China). Acupuncture method: the patients were placed in a sitting position. The skin was routinely sterilized with 75% alcohol. The needle was obliquely inserted into the Dinghui Acupoint to the extent that the patients felt swelling in the scalp. The needles were inserted into the Haoyi Acupoint and Xin Acupoint. The Mongolian medicine MY-I electric heating needle warmer (Research Center of Mongolian Medicine Clinical Apparatus of Inner Mongolia Medical University) was used to warm the needles at 38°C. One Acupoint was subject to treatment for 30 minutes 4 times each day. Nine days constitutes a course of treatment. Six courses of treatment were needed and treatment was performed at an interval of 3 days.
Drug group, estazolam (North China Pharmaceutical Co., Ltd., Batch number 152304): the dose of common usage was 1 mg. It was taken 15–30 minutes before sleep. The treatment time lasted for 56 days (see Figure
(a) Mongolian medicine MY-I electrical heating needle warmer; (b) position diagram for Dinghui Acupoint, Haoyi Acupoint, and Xin Acupoint; (c) acupuncture diagram for Dinghui Acupoint; (d) acupuncture diagram for Haoyi Acupoint; (e) acupuncture diagram for Xin Acupoint.
The Mongolian medicine syndromes and conditions were judged on the basis of scores of Mongolian medicine syndromes and conditions and by reference to Internal Medicine of Mongolian Medicine.
The scores were as follows: mild, less than 5 points; moderate, 6 points to 10 points; severe, 11 points to 15 points.
The Pittsburgh sleep quality index was used to assess the sleep quality of the subjects in recent 1 month. The full mark of the scale was 21 points. Judgment criteria for efficacy: A ratio of the scores before treatment minus the scores after treatment to the scores before treatment × 100% <30% indicated that there was no efficacy. A ratio ≥ 30% indicated that there was efficacy. A ratio ≥ 70% there was significant efficacy. A ratio ≥ 90% indicated that the patients made recovery [
The Embletta 13 (X100) lead portable polysomnography system (Medcare, Greensburg, PA, USA) was used to analyze the sleep structure. The indexes included total sleep time, awakening time, movement awakening time, awakening times, NREM, REM sleep time, and NREM S3∖S4 time. These indexes were measured before warm acupuncture and drug intervention and measured again 7 days after warm acupuncture and drug intervention [
The SPSS18.0 statistical software was used to analyze all data. The paired
There were 80 cases included in the paper. The Mongolian medical warm acupuncture group had 40 cases and the estazolam group had 40 cases. Group 1 was the Mongolian medical warm acupuncture group with 4 mild cases, 22 moderate cases, and 14 severe cases, 40 cases in total, 24 males and 16 females aged 21–65 years, age range
General data of patients.
Group | Number of cases | Sex | Course of disease (years) | Age (years) | Condition | |||
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Male | Female | Mild | Moderate | Severe | ||||
Warm acupuncture group | 40 | 24 | 16 |
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4 | 22 | 14 |
Drug group | 40 | 22 | 18 |
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4 | 19 | 17 |
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The gender comparison between both groups used chi-square test. The comparisons of course of disease and age used
There was no significant difference in scores of Mongolian medicine syndromes between the two groups based on
Indexes of Mongolian medicine syndromes and conditions.
Group | Number of cases | Scores before treatment | Scores after treatment |
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Warm acupuncture group | 40 | 11.56 ± 3.64 | 3.64 ± 1.08 | 6.302 | 0.000 |
Drug group | 40 | 12.27 ± 4.25 | 4.25 ± 1.69 | 10.524 | 0.000 |
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The efficacy result was judged using the score method. The full mark was 21 points. Efficacy judgment is ratio of difference of the score before treatment minus the score after treatment to the score before treatment × 100%: (1) recovery ≥ 9096; (2) significant efficacy ≥ 70%; (3) efficacy ≥ 3096; (4) no efficacy < 30%. The result was shown in Table
Analysis of clinical efficacy results.
Group | Number of cases | Recovery | Significant efficacy | Efficacy | No efficacy | Effective rate |
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Warm acupuncture group | 40 | 2 | 18 | 14 | 6 | 85% |
Drug group | 40 | 0 | 13 | 15 | 12 | 70% |
The total scores of PSQI in both groups before treatment were close. The
Note:
The mean value of all polysomnography indexes of the patients in both groups was subject to
Note:
Insomnia is a significant public health issue with a high morbidity. Insomnia may finally lead to psychological, physiological, and occupational health issues if no therapy is administered [
Many patients prefer nonmedicine treatment as orally administered drugs have a short duration of efficacy and long-term medication has drug dependence and drug withdrawal reactions [
Based on the clinical test, Mongolian medical warm acupuncture is able to better improve the patients’ sleep time and daytime functions. It is better than that in the estazolam group following drug withdrawal in term of improving the sleep time. It is more effective in helping the insomnia patients than hypnotics.
As a disease entity, the correlation between insomnia and electroencephalogram has aroused extensive attention. In foreign literature, it is further considered that a decreased REM latency period is the characteristic change in insomnia. In addition, there are such abnormalities as decreased S3 and S4 sleep, increased REM density, decreased sleep efficiency, and so forth [
Mongolian medical warm acupuncture can decrease the awakening times, the sleep hours in the REM period, and the REM sleep percentage and increase the NREM sleep hours. Meanwhile, the sleep quality, time for falling asleep, sleep hours, sleep efficiency, sleep disorders, daytime functions, and total scores improve significantly when compared with those before treatment. The Mongolian medical warm acupuncture group is better than the estazolam group in these indexes.
Long-term warm acupuncture treatment for the patients with significantly changed sleep physiological indexes of insomnia is able to bring some sleep indexes back to normal, such as REM sleep hours, sleep efficiency, and awakening time. Meanwhile, it plays a role in improving the characteristics indexes of insomnia, such as NREM3+4 stage. It is better than the current hypnotic treatment to a certain extent. The experiment provides clinical research verification for modern treatment with Mongolian medical warm acupuncture and scientific support for modernization development of the traditional ethnic medicine [
The authors declare that they have no competing interests.
This research is funded by the following projects: the Project of Incentive Funds for Guidance of Scientific and Technical Innovation in Inner Mongolia Autonomous Region, research on acupoints and operation technique standardization of Mongolian medicine warm needling therapy (no. 2014cztcxyd); National Natural Science Foundation of China, research on the hypnotic role of Mongolian medicine warm needling for rats with insomnia caused by PCPA and its mechanism (no. 81260571); Public Health Project of the State Administration of Traditional Chinese Medicine, research and promotion of Mongolian medicine brain shaking therapy for treatment of cerebral concussion (no. gjzyyglj 11 agl nzd); Public Health Project of the State Administration of Traditional Chinese Medicine, arrangement and annotation of literature on Mongolian medicine therapies (no. gjzyyglj 11 agl); National Natural Science Foundation of China, regulatory effects of Mongolian medical warm needle acupuncture on miRNAs and PAX8/APP protein in insomniac rats and mechanism study on insomnia treatment (no. 81560801); National Natural Science Foundation (no. 81550047); Science and Technology Innovation Fund of Provincial Department of Finance, Inner Mongolia Autonomous Region; Collaborative Innovation Project of Mongolian Medicine, Inner Mongolia Autonomous Region; Technology Reserve Project of Provincial Department of Science and Technology, Inner Mongolia Autonomous Region.