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OBJECTIVE To investigate the effects of Setaria italica extract on improving insomnia model mice and to explore its potential mechanisms. METHODS The mice were randomly assigned into blank group， model group， positive control group （diazepam， 2.6 mg/kg）， and S. italica extract low-dose， medium-dose and high-dose groups （1.2， 2.4， 4.8 g/kg）， with 10 mice in each group. Except for the blank group， all other groups received intraperitoneal injection of para-chlorophenylalanine （PCPA） to establish the insomnia model. After modeling， the blank group and model group were given a constant volume of normal saline intragastrically， and administration groups were given relevant medicine intragastrically， with a volume of 0.01 mL/g， once a day， for 7 consecutive days. After the administration， the open-field test was conducted to observe the praxiological changes of mice， and to determine the levels of 5-hydroxytryptamine （5-HT） and 5-hydroxyindoleacetic acid （5-HTAA） in the hippocampal tissue， as well as the contents of 5-HT， brain-derived neurotrophic factor （BDNF）， interleukin-2 （IL-2）， IL-6， B-cell lymphoma-2 （Bcl- 2）， and Bcl-2-associated X protein （Bax） in the serum. The expression of phosphoinositide 3-kinase/protein kinase B/nuclear factor- κB （PI3K/Akt/NF-κB） signaling pathway related protein was determined in the hippocampus of mice. RESULTS Compared with the model group， the total exercise time of mice in S. italica extract high-dose group was significantly prolonged， but the total rest time was significantly shortened （P＜0.01）； the number of standing times and modification times were significantly reduced （P＜ 0.01）. The contents of 5-HT， BDNF， and Bcl-2 in serum， and Bcl-2/Bax were significantly increased， while the contents of IL-2， IL-6， and Bax were significantly reduced （P＜0.05 or P＜ 0.01）. The content of 5-HTAA in the hippocampal tissue and 202104010910029）；the phosphorylation levels of PI3K and Akt proteins were increased significantly， while the phosphorylation level of NF-κB p65 protein was decreased significantly （P＜0.05）.CONCLUSIONS High-dose of S. italica extract demonstrates significant therapeutic effects on insomnia in mice， and the mechanism of which may be associated with the regulation of PI3K/Akt/NF-κB signaling pathway.
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Objective To observe the clinical efficacy of withdrawal therapy based on regulating nutritive qi and defensive qi(shortened to Tiaohe Yingwei method)in treating sedative-hypnotic dependent insomnia of disharmony between nutritive qi and defensive qi type.Methods Ninety patients with sedative-hypnotic dependent insomnia of disharmony between nutritive qi and defensive qi type were randomly divided into the treatment group and the control group,with 45 patients in each group.The control group was given oral use of Estazolam by 25%of weekly dose-reduction,while the treatment group was treated with Chinese medicinal decoction of Tiaohe Yingwei Zhumian Prescription based on Tiaohe Yingwei method together with Estazolam.The treatment course for the two groups lasted for 4 weeks.The changes of Pittsburgh Sleep Quality Index(PSQI)scores,total TCM syndrome scores,and Drug-withdrawal Syndrome Scale(DWSS)scores in the two groups were observed before and after treatment.After treatment,the efficacy for improving sleep efficiency value(IUSEV)and clinical safety in the two groups were evaluated.Results(1)During the trial,2 cases fell off in the treatment group,and 43 cases included in the statistics;3 cases fell off in the control group,and 42 cases included in the statistics.(2)After 4 weeks of treatment,the total effective rate for improving IUSEV of the treatment group was 88.37%(38/43),and that of the control group was 61.90%(26/42).The intergroup comparison by non-parametric rank-sum test showed that the efficacy for improving IUSEV in the treatment group was significantly superior to that in the control group(P＜0.05).(3)After treatment,obvious reduction was shown in the overall PSQI scores and the scores of the items of sleep quality,time for falling asleep,sleep time,sleep efficiency,sleep disorder and daytime dysfunction in the two groups when compared with those before treatment(P＜0.05).The intergroup comparison showed that except for the items of sleep disorder and daytime dysfunction,the treatment group had stronger effect on decreasing the scores of the remaining items and the overall PSQI scores than the control group(P＜0.05).(4)After treatment,the total scores of TCM syndromes of both groups were significantly decreased compared with those before treatment(P＜0.05),and the decrease of the total scores of TCM syndrome in the treatment group was significantly superior to that in the control group(P＜0.05).(5)After treatment,the total DWSS scores of the two groups were significantly decreased compared with those before treatment(P＜0.05),and the effect on lowering the scores in the treatment group was significantly superior to that in the control group(P＜0.05).(6)During the course of treatment,no significant adverse reactions occurred in the two groups,or no abnormal changes were found in the safety indexes such as routine test of blood,urine and stool,liver and kidney function,and electrocardiogram of the patients.Conclusion Withdrawal therapy based on Tiaohe Yingwei method exerts certain effect for the treatment of sedative-hypnotic dependent insomnia of disharmony between nutritive qi and defensive qi type.The therapy is effective on improving the quality of sleep and reducing the incidence of drug-withdrawal syndrome,and has a high safety.
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Objective To analyze the clinical efficacy of the Qianyang Fengsui Dan(combined with flying needle therapy)in the treatment of kidney-yang deficiency type of insomnia.Methods A retrospective study was conducted to select 82 patients with insomnia admitted to the Department of Traditional Chinese Medicine of Dezhou Hospital of Traditional Chinese Medicine from November 2020 to November 2021,and they were divided into an observation group and a control group according to whether or not they were treated with Qianyang Fengsui Dan combined with flying needle therapy,with 41 cases in each group.The control group was treated with Estazolam,while the observation group was treated with Qianyang Fengsui Dan combined with flying needle therapy on the basis of the treatment of the control group,and the course of treatment was 1 month.The changes of Pittsburgh Sleep Quality Index(PSQI)scores and Epworth Sleepiness Scale(ESS)scores,as well as polysomnographic parameters were observed before and after treatment in the two groups.The changes of γ-aminobutyric acid(GABA),glutamate(GA),substance P(SP),and neuropeptide Y(NPY)levels were compared before and after treatment between the two groups.And followed up for 1 year to compare the incidence of relapce of the two groups of patients.Results(1)The total effective rate was 95.12%(39/41)in the observation group and 63.41%(26/41)in the control group,and the efficacy of the observation group was superior to that of the control group,and the difference was statistically significant(P＜0.05).(2)After treatment,PSQI scores and ESS scores of patients in the two groups were significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving PSQI scores and ESS scores,and the differences were statistically significant(P＜0.05).(3)After treatment,sleep efficiency,awakening time,sleep latency,REM,and total sleep time were significantly improved in the two groups(P＜0.05),and the observation group was significantly superior to the control group in improving sleep efficiency,awakening time,sleep latency,REM,and total sleep time,and the differences were statistically significant(P＜0.05).(4)After treatment,the serum GABA,GA,SP,and NPY levels of patients in the two groups were significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving the serum GABA,GA,SP,and NPY levels,and the differences were all statistically significant(P＜0.05).(5)After treatment,follow-up for 1 year,the recurrence rate of the observation group was 0,and there were 7 cases of recurrence in the control group,and the recurrence rate of the control group was 17.07%(7/41),and the recurrence rate of the observation group was lower than that of the control group,and the difference was statistically significant(P＜0.05).Conclusion The combination of flying needle therapy and Qianyang Fengsui Dan can effectively relieve insomnia and fatigue in patients with insomnia,reduce daytime drowsiness,regulate the release of blood monoamine neurotransmitters,and reduce the relapse rate,and its efficacy is superior to that of simple western medicine treatment.
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Objective To observe the clinical efficacy of FANG's scalp acupuncture combined with timing auricular point pressing therapy in the treatment of insomnia patients with maintenance hemodialysis(MHD).Methods A total of 70 patients with insomnia on MHD were randomly divided into observation group and control group,with 35 patients in each group.Both groups were given conventional treatment,the control group was given oral use of Estazolam Tablets on the basis of conventional treatment,and the observation group was given FANG's scalp acupuncture combined with timing auricular point pressing therapy.Both groups were treated for a total of 4 weeks of treatment.After 1 month of treatment,the clinical efficacy of the two groups was evaluated,and the changes in the Pittsburgh Sleep Quality Index(PSQI)score and the Kidney Disease Quality of Life Short Form(KDQOL-SF)score,as well as the scores of the Hamilton Depression Scale(HAMD)and the Hamilton Anxiety Scale(HAMA),were observed in the patients of the two groups before and after treatment.The changes in hemoglobin(Hb),serum creatinine(Scr),and blood urea nitrogen(BUN)levels were compared before and after treatment between the two groups,and the safety of the two groups was evaluated.Results(1)After treatment,the PSQI and KDQOL-SF scores of patients in the two groups were significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving PSQI and KDQOL-SF scores,and the difference was statistically significant(P＜0.05).(2)After treatment,the HAMD and HAMA scores of patients in the two groups were significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving HAMD and HAMA scores,and the differences were statistically significant(P＜0.05).(3)After treatment,the Hb,Scr,BUN levels of patients in the two groups were significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving Hb,Scr,BUN levels,and the differences were all statistically significant(P＜0.05).(4)The total effective rate was 77.14%(27/35)in the observation group and 62.86%(22/35)in the control group.The efficacy of the observation group was superior to that of the control group,and the difference was statistically significant(P＜0.05).(5)Comparison of the incidence of adverse reactions in the two groups of patients,the difference was not statistically significant(P＞0.05).Conclusion FANG's scalp acupuncture combined with timing auricular point pressing therapy in the treatment of insomnia patients with MHD can effectively improve the sleep quality of patients and alleviate anxiety and depression,so as to improve the quality of life of patients,with remarkable efficacy.
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Objective To observe the clinical efficacy of acupuncture on ghost points combined with Longdan Xiegan Decoction in the treatment of post-stroke insomnia of liver-fire disturbing the heart type.Methods Sixty patients with liver-fire disturbing the heart type of post-stroke insomnia were randomly divided into observation group and control group,with 30 patients in each group.The control group was given oral use of modified Longdan Xiegan Decoction,and the observation group was given acupuncture at the ghost points on the basis of the treatment of the control group.Both groups were treated for 4 weeks.After 1 month of treatment,the clinical efficacy of the two groups was evaluated,and the changes in the Pittsburgh Sleep Quality Index(PSQI)score and the Athens Insomnia Scale(AIS)score were observed before and after treatment in the two groups.The changes of Self-Rating Depression Scale(SDS)scores were compared before and after treatment in the two groups of patients.Results(1)After treatment,the PSQI scores of the two groups of patients were significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving the PSQI scores,with a statistically significant difference(P＜0.05).(2)After treatment,the AIS scores of patients in the two groups were significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving the AIS scores,and the difference was statistically significant(P＜0.05).(3)After treatment,the SDS scores of patients in the two groups were significantly improved(P＜0.05),and the observation group was significantly superior to the control group in improving SDS scores,and the difference was statistically significant(P＜0.05).(4)The total effective rate of the observation group was 86.66%(26/30),while that of the control group was 76.66%(23/30).The efficacy of the observation group was superior to that of the control group,and the difference was statistically significant(P＜0.05).Conclusion Acupuncture at the ghost points combined with Longdan Xiegan Decoction for the treatment of liver-fire disturbing the heart type of post-stroke insomnia can significantly improve the clinical symptoms of the patients,and the therapeutic effect is remarkable.
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Objective To investigate the therapeutic effect of Huatan Jieyu Anshen Decoction(mainly with the actions of resolving phlegm,relieving depression and calming mind)combined with abdominal vibration tuina manipulations on chronic insomnia in the elderly.Methods Ninety-four cases of elderly patients with chronic insomnia of phlegm-heat harassing the interior type were randomly divided into the observation group and the control group,with 47 cases in each group.The control group was given Huatan Jieyu Anshen Decoction orally,while the observation group was given oral use of Huatan Jieyu Anshen Decoction combined with abdominal vibration tuina manipulations.The course of treatment for the two groups lasted for 4 weeks.Before and after the treatment,the two groups were observed in the changes of traditional Chinese medicine(TCM)syndrome scores,Pittsburgh Sleep Quality Index(PSQI)score,Athens Insomnia Scale(AIS)score,Fatigue Scale-14(FS-14)score,World Health Organization Quality-of-Life Brief Scale(WHOQOL-BREF)score,and the serum levels of melatonin(MT),dopamine(DA),and cortisol(CORT).After treatment,the clinical efficacy of the two groups was evaluated.Results(1)After 4 weeks of treatment,the total effective rate of the observation group was 97.88%(46/47),while that of the control group was 87.23%(41/47),and the intergroup comparison(tested by chi-square test)showed that the therapeutic efficacy of the observation group was superior to that of the control group(P＜0.01).(2)After treatment,the scores of primary and secondary TCM symptoms in the two groups were significantly decreased compared with those before treatment(P＜0.05),and the decrease of the scores of primary and secondary TCM symptoms in the observation group was significantly superior to that in the control group(P＜0.01).(3)After treatment,the PSQI scores,AIS scores,and FS-14 scores in the two groups were significantly decreased compared with those before treatment(P＜0.05),and the WHOQOL-BREF scores were significantly increased compared with those before treatment(P＜0.05).The decrease of the PSQI scores,AIS scores and FS-14 scores as well as the increase of the WHOQOL-BREF scores in the observation group was significantly superior to that in the control group(P＜0.01).(4)After treatment,the serum MT level of both groups was significantly higher than that before treatment(P＜0.05),and the serum DA and CORT levels were significantly lower than those before treatment(P＜0.05).The increase in serum MT level and the decrease in serum DA and CORT levels of the observation group were significantly superior to those of the control group(P＜0.01).Conclusion The combined therapy of Huatan Jieyu Anshen Decoction combined with vibration tuina manipulations can achieve satisfactory efficacy in the elderly patients with chronic insomnia of phlegm-heat harassing the interior syndrome.The therapy is effective on regulating the central nervous system of the patients,improving the quality of the sleep,and promoting the relief of fatigue and the enhancement of the quality of life,which has great significance to the enhancement of the overall therapeutic efficacy of insomnia.
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Objective To observe the therapeutic effect and mechanism of Modified Banxia Shumi Decoction on p-chlorophenylalanine(PCPA)-induced insomnia model rats.Methods Forty-eight male SD rats were randomly divided into six groups,i.e.,the normal group,the model group,the low-,medium-and high-dose groups of Chinese medicine and the Diazepam group,with 8 rats in each group.For 7 consecutive days before modeling,rats in the Chinese medicine low-,medium-and high-dose groups were treated with Modified Banxia Shumi Decoction for prophylactic treatment.Except for the normal group,PCPA-induced insomnia rat model was established in all groups.After modeling on day 1,each group continued to be administered the corresponding drug for 7 days.Body mass was monitored,open-field behavioral tests were performed,serum levels of orexin A(OXA)and orexin B(OXB)were detected by enzyme-linked immunosorbent assay(ELISA),the expression of hypothalamic orexin receptor 1(OX1R)was determined by immunohistochemistry,and hematoxylin-eosin(HE)staining was used to observe the pathologic changes in the hypothalamus of rats.Results(1)Before modeling,the growth trend of body mass of rats in each group was smooth,with no significant difference between groups;after modeling,except for the normal group,the growth rate of body mass of rats in each group slowed down or even declined;after 14 days of administration of Modified Banxia Shumi Decoction,the body mass of the Chinese medicine medium-dose group was significantly increased compared with that of the model group(P＜0.01).(2)Compared with the normal group,the model group showed an increase in the total distance of activity in the open field,the distance of activity in the central region and the number of times of entering the central region(P＜0.01),a significant increase in serum OXA and OXB contents(P＜0.01),a significant increase in the expression of hypothalamic OX1R(P＜0.01),and HE staining showed mild hyperplasia of the hypothalamic glial cells;compared with the model group,the total distance of activity in the open field,the distance of activity in the central region and the number of times entering the central region were reduced in the rats in the Chinese medicine medium-dose group and the Diazepam group(P＜0.01),the levels of serum OXA and OXB were significantly reduced(P＜0.01),the expression of hypothalamic OX1R was significantly reduced(P＜0.01),and the HE staining showed that a large number of neurons with perineurial interspace enlarged and the local glial cell hyperplasia.Conclusion Modified Banxia Shumi Decoction can improve insomnia and reduce anxiety in rats by down-regulating the levels of OXA and OXB in serum and the expression of OX1R in the hypothalamus.
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Objective We conduct a systematic review and meta-analysis to evaluate the efficacy and safety of Suanzaoren decoction for post-stroke insomnia.Methods We conducted a comprehensive literature search,including PubMed,EMbase,CNKI,WanFang Data and so on,from the database creating to September 15th 2023.Our systematic review only included randomized controlled trials(RCTs)concerning with Suanzaoren decoction in treating post-stroke insomnia.Two reviewers independently screened the literature,extracted the data,and assessed the risk of bias for included studies.We used RevMan 5.3 software to perform Meta-analysis.Results A total of 13 RCTs were included,involving 1002 patients.The meta-analysis results showed that the clinical effective rate of the Suanzaoren decoction group was higher than the control group(OR=4.25,95%CI 2.79 to 6.46,P<0.00001).The Suanzaoren decoction group(combined with other treatments)reduced the Pittsburgh sleep quality index(PSQI)score more significantly than the control group(MD=-2.78,95%CI-3.24 to-2.33,P<0.00001).The Suanzaoren Decoction group was better than the control group in reducing the score of the National Institute of Health Stroke Scale(NIHSS)and improving neurological impairment(MD=-1.58,95%CI-1.95 to-1.21,P<0.00001).The incidence of adverse events in Suanzaoren Decoction group was lower than that in the control group(OR=0.38,95%CI 0.20 to 0.71,P=0.003).Conclusion Suanzaoren decoction can enhance the clinical efficacy and improve the degree of neurological defect of post-stroke insomnia patients,Suanzaoren decoction(combined with other treatments)can improve the sleep quality.The incidence of adverse events is lower.However,the efficacy and safety of Suanzaoren decoction for post-stroke insomnia still need to be further verified by more high-quality RCTs.
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Insomnia disorder is the most common sleep disorder,which interacts with other diseases,caus-ing health damage to human body and imposing a significant socio-economic burden.Currently,there have been fur-ther advancements in subtypes of insomnia disorder,comorbidity research,mechanistic hypotheses,assessment strategies,and treatment methods.With the advent of the information age,digital platforms can integrate early warn-ing,accurate assessment and diagnosis,treatment methods,and later follow-up for insomnia disorder to establish a comprehensive and standardized system for the treatment and management of insomnia disorder,helping to alleviate a rising morbidity rate and save healthcare costs.
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Objective To explore the clinical effect of clinical observation of supplemented wendan decoction combined with Western medicine in treating insomnia accompanied by anxiety and depression in phlegm-heat internal disturbance syndrome.Methods A total of 120 cases of insomnia with anxiety and depression comorbiditis with phlegm heat disturbance syndrome were randomly divided into control group and treatment group,60 cases in each group.The control group was given escitalopram oxalate tablet combined with dexzopiclonone tablet,and the observation group was given added Wendan decoction on the basis of the control group.Both groups were treated continuously for 6 weeks.Polysomnography monitoring parameters and heart rate variability were compared between the two groups during baseline period and visit 2(baseline period+3 months).Scale scores of the two groups were compared during baseline period,visit 1(baseline period+6 weeks)and visit 2.The content of heart rate variability includes:time domain analysis(standard deviation of normal interval(SDNN),square root of the square sum of the mean of the difference between adjacent normal interval(RMSSD)and frequency domain analysis(LF,HF,LF/HF).The scale scores included the Pittsburgh Sleep Quality Index(PSQI)and Insomnia Severity Index(ISI)to assess sleep status,and the Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA),Self-assessment Scale for Depression(PHQ-9)and Generalized Anxiety Disorder Scale(GAD-7)to assess anxiety and depression status.Results(1)Polysomnography monitoring:the wake time of observation group was significantly shorter than that of control group,the number of awakenings was significantly less than that of control group,and the percentage of N3 and REM was significantly higher than these of control group(P＜0.05).(2)Heart rate variability:RMSSD and HF values in the observation group were significantly higher than those in the control group,and LF/HF values were significantly lower than those in the control group(P＜0.05).(3)In terms of sleep:during the interview,PSQI total score,sleep quality,hypnotic drugs and daytime dysfunction in the observation group were significantly lower than those in the control group(P＜0.05);At the 3 months,the sleep quality,hypnotic drugs and daytime dysfunction in the observation group were significantly lower than those in the control group(P＜0.05).In terms of emotion:HAMA,HAMD and GAD-7 scores were significantly lower than those of control group at 6 weeks(P＜0.05);At the 3 months,HAMA and GAD-7 scores were significantly lower than those of control group(P＜0.05).Conclusion Supplemented Wendan decoction combined with western medicine can obviously optimize the sleep structure of insomnia patients with anxiety and depressionof phlegm-heat disturbance syndrome,improve sleep continuity and deepen sleep depth,and improve parasympathetic functional activities,contribute to sympathetic parasympathetic balance,can improve insomniaand depression symptoms recently,and significantly improve anxiety symptoms in the short term,with good safety.
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Objective:To observe the effects of kidney-tonifying and mind-calming acupuncture therapy on sleep,mood,sex hormone levels,and traditional Chinese medicine(TCM)symptoms in patients with perimenopausal insomnia(PMI). Methods:A total of 90 patients with PMI were randomly divided into a treatment group and a control group,with 45 cases in each group.Patients in the treatment group were treated with acupuncture at Shenshu(BL23),Taixi(KI3),Baihui(GV20),and Anmian(Extra).The control group was treated with sham acupuncture.Both groups were treated 3 times a week for 4 weeks.Pittsburgh sleep quality index(PSQI)and insomnia severity index(ISI)were used to evaluate the sleep quality of the subjects before treatment,after treatment,and 1 month after treatment(follow-up).Beck depression inventory(BDI)and Beck anxiety inventory(BAI)were used to evaluate the depression and anxiety of the subjects before treatment,after treatment,and at 1-month follow-up.The TCM symptom scale was used to evaluate the TCM symptoms of the subjects before treatment,after treatment,and 1 month after treatment.Serum levels of estradiol(E2),follicle-stimulating hormone(FSH),and luteinizing hormone(LH)were measured before and after treatment. Results:During the study,2 cases dropped out of the treatment group,and no cases dropped out of the control group.The PSQI scores of the treatment group were significantly lower after treatment and at 1-month follow-up compared with those before treatment(P<0.05),and the difference was statistically significant compared with that of the control group(P<0.05).In the control group,the PSQI score was significantly lower after treatment compared with before treatment(P<0.05),and the difference was not statistically significant at 1-month follow-up compared with before treatment(P>0.05).Compared with the pre-treatment,the ISI,BDI,BAI,and TCM symptom scale scores of the treatment group were lower after treatment and at 1-month follow-up(P<0.05),and the differences with the control group at the same time point were statistically significant(P<0.05).The differences in ISI,BDI,BAI,and TCM symptom scale scores of the control group before treatment,after treatment,and at 1-month follow-up were not statistically significant(P>0.05).After treatment,the serum E2 level in the treatment group was significantly higher than that before treatment(P<0.05),and the difference with the control group was statistically significant(P<0.05).The difference in the serum E2 level before and after treatment in the control group was not statistically significant(P>0.05).The differences in the serum FSH and LH levels between before and after treatment were not statistically significant in either group of subjects(P>0.05). Conclusion:Kidney-tonifying and mind-calming acupuncture therapy can improve sleep quality,relieve anxiety and depression,delay the decrease of serum E2 level,and improve related TCM symptoms in patients with PMI.
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[Objective]To summarize the academic experience of Professor ZENG Qingqi in the use of classical prescription in the diagnosis and treatment of insomnia combined with reproductive system diseases.[Methods]Through clinical follow-up studying,reading ancient books,Professor ZENG's clinical experience in treating insomnia and reproductive system diseases was analyzed from the aspects of the treatment of insomnia with classical prescription,the treatment ideas of reproductive system diseases with classical prescription,and the concept of homotherapy for heteropathy in Chinese medicine for insomnia combined with reproductive system diseases,which was supported by medical cases.[Results]Professor ZENG's treatment of insomnia combined with reproductive system diseases follows the concept of homotherapy for heteropathy in Chinese medicine,advocating the use of the"five differentiation"diagnostic and treatment mode based on Chinese medicine viewpoint,such as body differentiation,disease differentiation,syndrome differentiation,local differentiation and micro differentiation,and paying attention to promoting medication according to the situation,combining warming and clearing,dredging and tonifying.It is believed that the key to the effectiveness of classical prescription in treating insomnia combined with reproductive system diseases lies in dealing with the problems of"suppressing hyperactivity"and"releasing",emphasizing the reconciliation between the relationship of heart(brain),heart and kidney,and not only dredging to treat the symptoms,but also cultivating and replenishing to treat the root cause.The patient in case one was of insomnia combined with impotence,identified as liver depression and Qi stagnation,spleen and kidney deficiency syndrome,modified Sini Powder and Shenqi Pills was used in treatment.Case two was of insomnia combined with menstruation,identified as disconnection of the heart and kidney,deficiency cold of Chong Ren and blood stasis blocking the uterus,treated with Huanglian Ejiao Decoction and Zhizishi Decoction combined with Wenjing Decoction.Both used classical prescriptions and achieved good results.[Conclusion]Professor ZENG specializes in the treatment of insomnia combined with reproductive system diseases with the use of meridian prescription,flexible identification,and appropriate prescription,with precise efficacy,its rich clinical experience is worth clinical learning and further promotion.
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ObjectiveTo investigate the effects of Guizhi Jia Longgu Mulitang on the expression difference of interleukin-10 （IL-10） and tumor necrosis factor -α （TNF-α） in related organs of insomnia rats with sensory dysfunction dominated by lung and study the mechanism of Guizhi Jia Longgu Mulitang in improving insomnia. MethodSD rats were randomly divided into the blank group， model group， western medicine group， and traditional Chinese medicine （TCM） group， with 10 rats in each group. The rats were deprived of sleep by shallow water environment method in a long platform， and the modeling lasted for 42 d. The blank group and model group were given 0.05 mL·kg-1 normal saline by gavage， and the western medicine group and TCM group were given drugs during modeling. To be specific， the western medicine group was given 0.105 mg·kg-1 dexzopiclone tablet by gavage， while the TCM group was given 7 600 mg·kg-1 Guizhi Jia Longgu Mulitang by gavage， both lasting for 28 days. After successful modeling， the Morris water maze experiment was performed on the 42nd day to detect the motion and spatial memory ability of rats. The levels of IL-10 and TNF-α in serum were detected by enzyme-linked immunosorbent assay （ELISA）. The protein expression of IL-10 and TNF-α in the lung and brain tissue of rats was detected by Western blot. The levels of IL-10 and TNF-α in the lung and brain tissue of rats were detected by immunohistochemistry. ResultCompared with the blank group， the sleep stages non-rapid eye movement ( NREM ) and rapid eye movement ( REM ) of the model group were significantly shortened （P<0.5， P<0.01）， and the wake stage was significantly increased （P<0.01）. The total time and distance of platform exploration were significantly increased （P<0.01）. In the target quadrant （the third quadrant）， the percentage of exploration time and the times of crossing the platform were significantly decreased （P<0.01）. ELISA results showed that the serum IL-10 level was significantly decreased （P<0.01）， and TNF-α level was significantly increased （P<0.01）. The results of Western blot showed that the protein expression of IL-10 in brain and lung tissue of rats was significantly decreased （P<0.01）， and the protein expression of TNF-α was significantly increased （P<0.01）. The results of immunohistochemistry showed that the expression of IL-10 in the brain and lung tissue of rats was significantly decreased （P<0.01）， and that of TNF-α was significantly increased （P<0.01）. Compared with the model group， the NREM stage and REM stage of the western medicine group and the TCM group were significantly increased （P<0.5， P<0.01）， and the wake stage was shortened （P<0.5）. The total time and distance of platform exploration were significantly decreased （P<0.01）. In the target quadrant （the third quadrant）， the percentage of exploration time and the times of crossing the platform were significantly increased （P<0.05， P<0.01）. The serum IL-10 level was significantly increased （P<0.01）， and the serum TNF-α level was significantly decreased according to the ELISA results （P<0.01）. The results of Western blot showed that the protein expression of IL-10 in brain tissue and lung tissue was significantly increased （P<0.01）， and the protein expression of TNF-α was significantly decreased （P<0.01）. The results of immunohistochemistry showed that the expression of IL-10 in brain tissue and lung tissue was significantly increased （P<0.05， P<0.01）， and the expression of TNF-α was significantly decreased （P<0.05， P<0.01）. ConclusionGuizhi Jia Longgu Mulitang can improve the expression of IL-10 and TNF-α in brain and lung tissue of insomnia rats with sensory dysfunction dominated by lung， prolong sleep time， and then improve insomnia. The mechanism may be related to improving the expression level of inflammatory factors.
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By sorting out the different understandings by ancient and modern doctors on "stomach disharmony leading to restlessness"， this paper found that the difference is whether "restlessness" means being unable to lie down or to sleep peacefully， and pointed out the limitations of the two views. The passage of Basic Questions on Diseases Caused by Qi Counterflow and Irregularities （《素问·逆调论篇》） comprehensively explains the etiology， location， and condition of qi counterflow syndrome by taking qi counterflow as the principle， "breathing" disturbance caused by the unfavorable qi movement of the lungs， stomach， and kidneys as the main manifestation， and whether one can lie down and take activities as the standards. It is pointed out that "stomach disharmony leading to restlessness" is not the original text of the Inner Canon of Yellow Emperor （《黄帝内经》）， and it may be a derivative of the mistakenly posted comments.
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ObjectiveTo explore the effectiveness and safety of vibration-kneading abdominal tuina as an adjunct treatment for insomnia of phlegm-heat harassing the interior syndrome with "stomach disharmony" symptom. MethodsSeventy-six insomnia patients of phlegm-heat harassing the interior syndrome with "stomach disharmony" symptom were recruited， and randomly divided into the treatment group and the control group with 38 cases in each group. The control group received eszopiclone 2mg once a night and sleep hygiene guidance， while the treatment group received vibration-kneading abdominal tuina additionally， 5 times a week， 30 min each time. Both groups were treated for 4 weeks. The Pittsburgh Sleep Quality Index （PSQI） （including sleep quality， time to fall asleep， sleep duration， sleep efficiency， sleep disorders， daytime functioning scores， and total scores） and traditional Chinese medicine （TCM） symptom scores of "stomach disharmony" was assessed before and after 4-week treatment and at follow-up （12 weeks after treatment）. Adverse events were also observed and recorded during the study. Pearson correlation analysis was used to assess the correlation between the pre-treatment PQSI total score and TCM symptom score of "stomach disharmony". ResultsThe PSQI scores of sleep quality， time to fall asleep， sleep duration， sleep efficiency， sleep disorders， daytime dysfunction scores， and total scores reduced in both groups decreased after treatment and at follow-up （P＜0.05 or P＜0.01）， as well as the TCM symptom score of "stomach disharmony" （P＜0.01）. After treatment， the PSQI scores of sleep quality， sleep duration， and TCM symptom score of "stomach disharmony" of the treatment group were lower than those of the control group （P＜0.05 or P＜0.01）. At follow-up， the PSQI scores of sleep quality， sleep duration， sleep efficiency， daytime dysfunction score， total score， and TCM symptom score of "stomach disharmony" of the treatment group were lower than those of the control group （P＜0.05 or P＜0.01）. No adverse reactions occurred in any participants during the study. There was a positive correlation between the patients' pre-treatment PQSI total scores and TCM symptom score of "stomach disharmony" （r=0.88， P＜0.01）. ConclusionVibration-kneading abdominal tuina as an adjunct treatment could significantly improve the symptoms of stomach and epigastric symptoms in insomnia patients of phlegm-heat harassing the interior syndrome with "stomach disharmony" symptom， and improve the quality of sleep， with good immediate and long-term therapeutic effects， and sound safety.
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This paper summarized Professor HAN Mingxiang's clinical experience in treating insomnia in the elderly based on the theory of “deficiency leading to stasis”. It is believed that the core pathogenesis of insomnia in the elderly lies in the weakness of the zang-fu （脏腑） organs and the obstruction of the heart vessel. He advocates the basic treatment principles of supplementing deficiency and dispelling stasis， calming the heart and mind. For insomnia in the elderly with a pattern of heart-spleen deficiency， modified Buyang Huanwu Decoction （补阳还五汤） and Guipi Decoction （归脾汤） could be prescribed to tonify qi， nourish blood， and calm the heart and spirit. For pattern of liver-kidney yin deficiency， modified Qiju Dihuang Decoction （杞菊地黄汤） and Suanzaoren Decoction （酸枣仁汤） could be prescribed to nourish yin， clear heat， cool blood， and tranquilize mind. For pattern of kidney yang deficiency， modified Yougui Pill （右归丸） and Taohong Siwu Decoction （桃红四物汤） could be prescribed to warm yang， dispel cold， eliminate stagnation， and tranquilize the spirit. For pattern of phlegm-dampness stagnation， Xuefu Zhuyu Decoction （血府逐瘀汤） and Wendan Decoction （温胆汤） could be prescribed to resolve phlegm， dispel dampness， eliminate stagnation， and tranquilize the mind.
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OBJECTIVE To investigate the efficacy and safety of Wuling capsules combined with low-dose quetiapine in the treatment of oldest-old patients with insomnia accompanied by anxiety and depression. METHODS The clinical data of 96 oldest- old patients （aged≥80 years） with insomnia accompanied by anxiety and depression who were attending outpatient clinics or hospitalized in our hospital from June 2020 to December 2022 were retrospectively analyzed. According to the different drug treatments， the patients were divided into Wuling capsules group （0.99 g， tid， 34 cases）， quetiapine group （25-50 mg， qn， 30 cases） and combination group （using Wuling capsules and quetiapine simultaneously， same as the single drug groups， 32 cases）. Before and after 8 weeks of treatment， the patients of three groups were compared in terms of photoplethysmography sleep monitoring indexes （total sleep duration， sleep efficiency， sleep latency， and the number of awakening）， Pittsburgh sleep quality index （PSQI） score， 14-item Hamilton anxiety scale （HAMA-14） score， 17-item Hamilton depression scale （HAMD-17） score， mini-mental state examination （MMSE） score， and serum levels of interleukin-1β （IL-1β） and tumor necrosis factor-α （TNF-α）； the therapeutic effects and adverse drug reactions of the three groups were observed and compared. RESULTS Compared with before treatment， the total sleep time， sleep efficiency and MMSE scores of the three groups were significantly longer or higher after treatment （P＜0.05）， while the sleep latency， number of awakening， PSQI score， HAMA-14 score， HAMD-17 score， serum IL-1β and TNF-α levels were significantly shorter or lower after treatment （P＜0.05）. Sleep latency， number of awakening， HAMA-14 score， HAMD-17 score and serum TNF-α level in quetiapine group were significantly shorter or lower than Wuling capsules group after treatment （P＜0.05）. Moreover， the above indexes in the combination group were significantly better than quetiapine group and Wuling capsules group （P＜0.05）. The total effective rate of treatment in the combination 1731786794@qq.com group was significantly higher than the other two groups （P＜0.05）. There was no significant difference in the incidence of mail：2408797210@qq.com adverse drug reactions among the three groups （P＞0.05）. CONCLUSIONS The therapeutic effect of Wuling capsules combined with low-dose quetiapine is better than that of individual drugs for oldest-old patients with insomnia accompanied with anxiety and depression， not increasing the risk of adverse reactions.
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ObjectiveTo explore the effect and mechanism of the classic famous prescription Anmeidan （AMD） developed in the Qing Dynasty in regulating the hepatic neurotransmitters and circadian rhythm in the rat model of insomnia via the orexin-1 receptor （OX1R）/phosphatidylinositol-specific phospholipase Cβ-1 （PLCβ-1）/protein kinase Cα （PKCα）/extracellular signal-regulated kinase 1/2 （ERK1/2） signaling pathway. MethodSixty SPF-grade SD rats were randomized into blank， model， suvorexant （30 mg·kg-1·d-1）， and low-， medium-， and high-dose （4.55， 9.09， 18.09 g·kg-1·d-1， respectively） AMD groups， with 10 rats in each group. The rats in other groups except the blank group were modeled by intraperitoneal injection of p-chlorophenylalanine （PCPA） and administrated with corresponding drugs by gavage， and the blank group received an equal volume of normal saline. The general condition， body mass， and 24 h autonomic activity of each group were observed. The pathological changes of the liver tissue were observed by hematoxylin-eosin（HE）staining and Masson staining. The expression of gamma-aminobutyric acid （GABA）， 5-hydroxytryptamine （5-HT）， epinephrine （EPI）， norepinephrine （NE）， and acetylcholine （ACh） in the liver tissue was detected by enzyme-linked immunosorbent assay. The glutamate （Glu） expression in the liver tissue was detected by the biochemical method. The mRNA levels of biological clock genes Per1， Per2， Cry1， Cry2， Bmal1， and Bmal2 in the liver were determined by Real-time fluorescence quantitative polymerase chain reaction（Real-time PCR）. The protein and mRNA levels of factors in the OX1R/PLCβ-1/PKCα/ERK1/2 signaling pathway in the liver were determined by Western blot and Real-time PCR， respectively. ResultCompared with the blank group， the modeling decreased the body mass （P<0.05， P<0.01） and caused mania and disturbed resting rhythms （P<0.01）， hepatic muscle fiber fracture， and edema with inflammatory cell infiltration. In addition， the modeling decreased the GABA， 5-HT， EPI， NE， and ACh content， increased Glu content （P<0.01）， down-regulated the mRNA levels of Per1， Per2， Cry1， and Cry2 （P<0.01）， up-regulated the mRNA levels of Bmal1 and Bmal2 （P<0.01）， and promoted the expression of OX1R， PLCβ-1， PKCα， and ERK1/2 at both protein and mRNA levels （P<0.01）. Compared with the model group， suvorexant and AMD increased the body mass （P<0.05， P<0.01）， alleviated the mania， and increased the resting time and frequency （P<0.05， P<0.01）. Moreover， the medications elevated the levels of GABA， 5-HT， EPI， NE， and ACh， lowered the Glu level， up-regulated the mRNA levels of Per1， Per2， Cry1， and Cry2 （P<0.05， P<0.01）， down-regulated the mRNA levels of Bmal1 and Bmal2， and inhibited the expression of OX1R， PLCβ-1， PKCα， and ERK1/2 at both mRNA and protein levels （P<0.05， P<0.01）. ConclusionAMD can regulate hepatic neurotransmitters and improve circadian rhythm in insomniac rats by inhibiting the OX1R/PLCβ-1/PKCα/ERK1/2 signaling pathway， and high-dose AMD demonstrated the strongest effect.
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OBJECTIVE To study the effects of the Mongolian medicine Sugemule-4 on the metabolism of insomnia rats， and to preliminarily explore its possible mechanisms for improving insomnia. METHODS The rat model of chronic stress insomnia was established by tail clipping stimulation and intraperitoneal injection of p-chlorophenyl alanine solution. Twenty-four male rats were randomly divided into the normal group， model group， diazepam group （positive control， 0.92 mg/kg）， and Sugemule-4 group （5.2 g/kg）， with 6 rats in each group. Since the 7th day of tail clipping stimulation， the Sugemule-4 group and diazepam group began to be intragastrically administered with relevant medicine； the normal group and model group were intragastrically administered with an equal volume of distilled water， once a day， for 14 consecutive days. The learning and memory abilities of rats were tested using a water maze experiment， and the non-invasive sleep activity monitoring system was used to monitor the 24- hour sleep time of rats. A metabolomics study was conducted on rat serum and hippocampal tissue by using ultra-high-performance liquid chromatography-tandem mass spectrometry. The multivariate statistical analysis method was adopted to analyze the differential metabolites in serum and hippocampal tissue of rats， and screen for differential metabolites and metabolic pathways among those groups. RESULTS Compared with the normal group， the escape latency of rats in the model group was significantly increased， the times of crossing platforms were significantly reduced， and the percentage of average 24-hour sleep time was significantly reduced （P＜0.05）. Compared with the model group， the levels of the above indicators were significantly reversed in the diazepam group and Sugemule-4 group （P＜0.05）. Metabolomics studies found that a total of 9 differential metabolites were identified in rat serum and hippocampal tissue， including 5-hydroxyindoleacetic acid， canine urate， canine urinary quinolinic acid， 5-hydroxytryptamine， phenol sulfate， 1-carboxyethyltyrosine， 3-（4-hydroxyphenyl） lactate， N-acetyl tyrosine， tyrosine and phenol sulfate， mainly involving 2 metabolic pathways of tryptophan and tyrosine.CONCLUSIONS Sugemule-4 can improve the sleep time and behavioral performance of insomnia rats， and its mechanism may be associated with affecting amino acid metabolic pathways such as tryptophan and tyrosine.
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BackgroundChronic insomnia is characterized by a prolonged and recurrent course. The efficacy of repeated transcranial magnetic stimulation （rTMS） as a physical therapy method to improve sleep quality remains inadequately supported by evidence， particularly regarding its relationship with personality traits. ObjectiveTo explore the efficacy and influencing factors of rTMS in the treatment of chronic insomnia， and to provide insights into its therapeutic potential. MethodA total of 46 patients who met the diagnostic criteria for chronic insomnia according to the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5）， and were treated at the Third Hospital of Mianyang from September 2022 to September 2023 were selected. Prior to treatment， participants underwent assessments using the Eysenck Personality Questionnaire （EPQ）， Hamilton Depression Scale-17 item （HAMD-17） and Hamilton Anxiety Scale （HAMA）. The Pittsburgh Sleep Quality Index （PSQI） was used to assess sleep quality before treatment， at the end of the second week of treatment and one week post-treatment. ResultsAt the end of the second week of treatment， patients exhibited significantly improved total PSQI score and subscale scores related to subjective sleep quality， sleep latency， sleep duration， sleep efficiency， sleep disturbance and daytime dysfunction （t=4.755~13.361， P<0.01）， with 24 cases （54.35%） showing effective treatment outcomes. Multiple linear regression analysis showed that introverted and extroverted personality traits contributed significantly to the regression equation （B=0.317， P<0.01）， explaining 29.90% of the total variation （R2=0.299）. ConclusionrTMS treatment may effectively improve the sleep quality of patients with chronic insomnia， with its therapeutic effect appearing to associated with introverted and extroverted personality traits. ［Funded by National Natural Science Project of China （number， 82372080）］