[Progress of mechanism research on the neurotransmitters in treatment of insomnia with acupuncture by regulating sleep architecture].

Low-quality sleep in patients with insomnia is closely related to sleep architecture imbalance and neurotransmitter impairment. Acupuncture may reduce the duration of light sleep and its proportion, increase the time of deep sleep and rapid- eye-movement sleep as well as their proportions so as to modulate the sleep architecture for insomnia. The paper summarized the related studies of acupuncture for improving sleep architecture through regulating serotonin, norephinephrine, dopamine, γ-aminobutyric acid, acetylcholine and orexin; and explored the effects of acupuncture on the neurotransmitters and their specific performance in regulating sleep architecture. It is anticipated that the review may provide the literature evidences of acupuncture for improving sleep quality in patients with insomnia, and the approaches to the mechanism research of acupuncture for regulating sleep architecture.

[Acupoint compatibility effect and mechanism of Shenmen (HT7) and Sanyinjiao (SP6) in improving daytime fatigue and sleepiness of insomnia].

OBJECTIVE: To observe the acupoint compatibility effect of Shenmen (HT7) and Sanyinjiao (SP6) in improving daytime fatigue and sleepiness of insomnia, and its mechanism in regulating hypothalamic-pituitary-adrenal (HPA) axis and suprachiasmatic nucleus-pineal gland-melatonin (SCN-PG-MT) system. METHODS: Ninety patients with insomnia were randomly divided into HT7, SP6 and HT7-SP6 (HT7 plus SP6) groups, with 30 cases in each group. Electroacupuncture (EA,5 Hz/25 Hz) was applied to HT7, SP6 or HT7-SP6 in each group for 30 min. The EA treatment was conducted once daily, 5 days a week for 2 weeks. Before and after treatment, the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were observed, separately. The contents of serum adrenocorticotrophic hormone (ACTH), cortisol (CS) and melatonin (MT) were detected by ELISA. RESULTS: Compared with before treatment, the sleep quality, sleep time, sleep efficiency, sleep disturbance, daytime dysfunction scores and total score of PSQI in the three groups after treatment were decreased (P<0.05), the time to fall asleep score of PSQI and total score of ESS were decreased in the SP6 and HT7-SP6 groups (P<0.05). After treatment, the sleep quality, time to fall asleep, sleep efficiency, daytime dysfunction scores, total score of PSQI and total score of ESS in the HT7-SP6 group were lower than those in the HT7 group (P<0.05), the sleep quality, sleep efficiency and total score of PSQI in the SP6 group were lower than those in the HT7 group (P<0.05). Compared with before treatment, the serum ACTH and CS levels in the three groups were decreased (P<0.05), and the serum MT levels in the SP6 and HT7-SP6 groups were increased (P<0.05). After treatment, the ACTH and CS levels in the HT7-SP6 group were lower than those in the HT7 group (P<0.05), and the serum MT levels in the SP6 and HT7-SP6 groups were higher than that in the HT7 group (P<0.05). CONCLUSION: The compatibility of HT7 and SP6 has a synergism effect on the improvement of night sleep quality and daytime fatigue and sleepiness of insomnia patients, the mechanism may be related with its function in down-regulating the serum ACTH and CS levels and increasing the serum MT content. SP6 has a better effect than HT7, and plays a major role in acupoint compatibility.

[Combined use of Shenmen (HT 7) and Sanyinjiao (SP 6) to improve the anxiety and depression in patients with insomnia: a randomized controlled trial].

OBJECTIVE: To observe the effect of electroacupuncture (EA) at Shenmen (HT 7) and Sanyinjiao (SP 6) on anxiety and depression in patients with insomnia, and to explore the mechanism of its compatibility effect. METHODS: Ninety patients of insomnia were randomly divided into a combination group, a Shenmen group and a Sanyinjiao group, 30 cases in each group. In addition, 37 cases with anxiety (12 cases in the combination group, 13 cases in the Shenmen group and 12 cases in the Sanyinjiao group) and 42 cases with depression (14 cases in the combination group, 14 cases in the Shenmen group and 14 cases in the Sanyinjiao group) were identified. The patients in the combination group, Shenmen group and Sanyinjiao group were treated with EA (dilatational wave, frequency of 5 Hz/25 Hz) at Shenmen (HT 7)-Sanyinjiao (SP 6), Shenmen (HT 7) and Sanyinjiao (SP 6), respectively, 30 min each treatment, once a day. The consecutive 5 days of treatments were taken as a course of treatment, and 2 courses of treatment were given. The insomnia severity index (ISI), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores were evaluated before and after treatment, and the serum contents of dopamine (DA) and norepinephrine (NE) were measured. RESULTS: Compared before treatment, the ISI, SAS and SDS scores in the three groups were all decreased after treatment (P<0.05), and the ISI score in the combination group was lower than that in the Shenmen group (P<0.05). Among the patients with anxiety, compared before treatment, the ISI, SAS scores and serum contents of DA were all decreased after treatment in the three groups (P<0.05), and the serum contents of NE in the combination group and Shenmen group were decreased after treatment (P<0.05); the SAS score and serum contents of NE in the combination group and Shenmen group as well as the ISI score in the combination group were lower than those in the Sanyinjiao group (P<0.05). Among the patients with depression, compared before treatment, the ISI, SDS scores and serum contents of DA were all decreased after treatment in the three groups (P<0.05), and the serum contents of NE in the combination group and Shenmen group were decreased after treatment (P<0.05); the ISI, SDS scores and serum contents of NE in the combination group as well as SDS score in the Shenmen group were lower than those in the Sanyinjiao group (P<0.05). CONCLUSION: EA at Shenmen (HT 7) and Sanyinjiao (SP 6) has advantages over EA at Sanyinjiao (SP 6) on improving insomnia, anxiety and depression. Shenmen (HT 7) plays a major role in improving anxiety and depression. Shenmen (HT 7) and Sanyinjiao (SP 6) may play a compatibility effect of regulating consciousness and sleeping by reducing the level of serum NE.

[Effect of electroacupuncture at "Shenmen"(HT7) and "Sanyinjiao"(SP6) on energy metabolism in paraventricular nucleus of hypothalamus of insomnia rats].

OBJECTIVE: To observe the effect of electroacupuncture(EA) at "Shenmen"(HT7) and "Sanyinjiao"(SP6)on energy metabolism in paraventricular nucleus (PVN) of hypothalamus in insomnia rats, so as to explore its mechanism underlying improvement of insomnia. METHODS: A total of 66 SD rats (half male and half female) were randomized into 3 groups：normal control, model and EA groups(n＝22 per group). The insomnia model was established by binding the rat for at least 4 h (step increase of 30 min per day), once daily for 15 days. EA (5 Hz /25 Hz, 0.5－1.0 mA) was applied to unilateral HT7 and SP6 for 15 min, once daily for 5 days. The rats' spontaneous activities during day and night were recorded by using the ClockLab Data Collection and Analysis System, and the duration of exhausted swimming was detected by using load-bearing endurance swimming test. The expression of adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK) of PVN tissue was assayed by Western blot, and the contents of acetyl coenzyme A (Ac-CoA) and Na＋-K＋adenosine triphosphatase (Na＋-K＋-ATPase) in the PVN tissue, and corticosterone (CORT) in plasma were assayed by ELISA. Changes of the ultrastructure of PVN cells were observed by transmission electron microscope. RESULTS: After modeling, the rats' daytime and nocturnal locomotor activities were significantly increased and decreased, respectively (P<0.05), and the duration of exhausted swimming was considerably shortened in the model group compared with that of the normal control group (P<0.05). The expression level of AMPK protein in the PVN was obviously up-regulated (P<0.05), and the contents of Ac-CoA and Na＋-K＋-ATPase in PVN and CORT in plasma were markedly decreased in the model control group relevant to the normal group (P<0.05). After EA intervention, the increased daytime locomotion and the decreased nocturnal activities, the shortened duration of exhausted swimming, the up-regulated expression of AMPK, and the decreased Ac-CoA, Na＋-K＋-ATPase and CORT contents were all reversed in the EA treated rats relevant to those of the insomnia rats (all P<0.05). Moreover, ultrastructural observation showed mitochondrial swelling and disappearance of partial ribosomes in the plasma of PVN cells in the model group, while in the EA group, only mild swelling of some mitochondria was found, being with basically normal nuclear membrane, mitochondria, rough endoplasmic reticulum, Golgi complex and ribosomes. CONCLUSION: EA at HT7 and SP6 has a positive effect in improving insomnia and insomnia-induced fatigue in insomnia rats, which may be associated with its effects in restraining the expression of AMPK protein, and up-regulating the contents of Ac-CoA and Na＋-K＋-ATPase in PVN and CORT in plasma.

[Discussion on the constructing principle of syndrome differentiation system according to meridian and collateral theories].

According to the meridian and collateral theories in the Internal Classic, the authors proposed that the construction of the syndrome differentiation system with science characteristics of acupuncture and moxibustion should follow the principle of systemic structure and physiological function. The establishment of the whole frame structure of syndrome differentiation system according to meridian and collateral theories should base on the principle of systemic structure and the establishment of symptom of each syndrome should base on the principle of physiological function.

[Effect of electroacupuncture at Shenshu (BL 23) and Zusanli (ST 36) on the event-related potentials of chronic fatigue syndrome].

OBJECTIVE: To observe the effective mechanism of electroacupuncture for chronic fatigue syndrome (CFS). METHODS: The dynamic detection of chronobiology was used to test the event-related potentials in 20 healthy subjects and 20 CFS patients. P3a and P3b latencies at 4 equidistant time points (8:00, 14:00, 20:00, 2:00) within 24 hours were collected and analyzed. RESULTS: (1) Latency of P3a in CFS group was obviously prolonged at 14:00 compared to health group with statistical significance (P < 0.05), latency of P3b was decreased at 14:00 after electroacupuncture treatment with statistical significance compared to that of pre-treatment (P < 0.01). (2) There were obviously circadian rhythm in latency of P3a and P3b in health group (P < 0.05), which were not seen in CFS group (P > 0.05); the circadian rhythm latency of P3b restored after treatment (P < 0.05). (3) The latency acrophase of P3a and P3b pre-treatment obviously shifted backward compared to that of healthy subjects (P < 0.05), shifted forward after electroacupuncture treatment (P < 0.05). CONCLUSION: The event-related potential circadian rhythms are lost in CFS patients. Electroacupuncture at Shenshu (BL 23) and Zusanli (ST 36) can regulate the circadian rhythm of P3a and P3b latency and improve the cognition of the patients in daytime.

[On effects of acupoints and drugs in acupoint-injection treatment].

Acupoint-injection therapy is a successful sample for clinical application of integrated Chinese and Western medicine, and has widely been applied clinically. In this method, effects of meridians, acupoints and drugs are organically combined, with obviously higher total therapeutic effect compared with routine acupuncture and moxibustion, intermuscular injection or intravenous injection. In this paper, the total therapeutic effects of acupoint-injection, high effectiveness of drugs and integrated action of acupoint and drug were discussed mainly and it is considered that the basic reason of acupoint-injection producing the high effect of drug is due to meridians and acupoints integrating some pharmacological actions of drugs.