子午流注法取穴治疗失眠研究述评  

Study Review of Acupoint and Meridian Stream Method in Treatment of Insomnia

作　　者：刘臻[1] 赵娜[1] 付聪[1] 高晓林[1] 于心同[1] 陈云飞[1] LIU Zhen;ZHAO Na;FU Cong;GAO Xiaolin;YU Xintong;CHEN Yunfei(Yueyang Hospital of Integrative medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai China 20043)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院,上海200437

出　　处：《中医学报》2018年第5期894-898,共5页Acta Chinese Medicine

基　　金：国家自然科学基金青年项目(81503631);上海市科学技术委员会中医引导类项目(16401931800)

摘　　要：在运用子午流注法取穴治疗失眠的文献中,虽然研究结果均提示其治疗失眠疗效显著,但纵观现有研究不难发现其中也存在如下问题:(1)对照组设置方面:现有研究主要选择传统辨证取穴或西药为对照组,然而辨证取穴不统一,药物使用种类及剂量亦有较大差异。(2)临床病例的纳入标准及排除标准设置方面:现有研究多参照美国睡眠医学会发布的睡眠障碍国际指南制定,然而多数未严格排除睡眠相关其他疾病(睡眠呼吸暂停、快速动眼睡眠行为障碍等)以及精神类疾病(中重度焦虑、抑郁等),从而可能对研究结果的准确性造成影响。(3)疗效评价指标选择方面:现有研究多以国家中医药管理局制定的《中药新药治疗失眠的临床研究指导原则》为标准,选用有效率作为主要评价指标,评价工具则多选用匹兹堡睡眠治疗指数量表(Pittsburgh Sleep Quality Index,PSQI)等主观评价工具,而缺乏应用客观疗效评价工具对受试者睡眠改善情况进行准确评估,如采用多导睡眠监测(Polysomnography,PSG)等客观评价睡眠变化,并排除失眠相关其他疾病对研究可能产生的影响,疗效评估的准确性有待提高。(4)疗效评定时间设置方面:现有研究多选择治疗前、治疗后两个时间点进行数据评估分析,集中分析子午流注法取穴对患者失眠干预效果的即时效应,而对于干预的长期效应及安全性缺乏有效的评估。在今后的研究中,要以现代时间生物学、时间医学中的病理生理节律研究为基础,借鉴其标准化的研究方法,深入挖掘传统子午流注学说的合理内涵,寻求符合客观规律并宜推广的择时选穴方法,同时探索简便的取穴推算方法,以更好地为失眠患者提供服务。In the literature of treatment of insomnia by using acupoint and meridian stream method,although the results of the study suggest that the efficacy is significant,it is not difficult to find the following problems in the existing researches：（1） Acupoint choosing of the control group： The existing study mainly uses traditional acupoint selection or western medicine to treat the control group. However,the acupoint selection and differentiation were not uniform,and the types and doses of drugs used were also significantly different.（2） Inclusion criteria and exclusion criteria for clinical cases： The existing studies are mostly based on the International Guidelines for Sleep Disorders issued by the American Sleep Medicine Association. However,most sleep-related diseases(sleep apnea,rapid eye movement sleep behavior disorder,etc.） are not strictly excluded.） as well as mental illnesses(moderate to severe anxiety,depression,etc.）,which may affect the accuracy of the research results.（3） Efficacy evaluation index selection：Most of the existing studies are based on the ＂ Guidelines for clinical research on the treatment of insomnia with new Chinese medicines＂ formulated by the State Administration of Traditional Chinese Medicine. The efficiency is used as the main evaluation index,and the Pittsburgh sleep treatment index is used as the evaluation tool. Subjective evaluation tools such as the Pittsburgh Sleep Quality Index(PSQI）,and there is a lack of objective evaluation tools for accurate assessment of sleep improvement in subjects,such as using polysomnography(PSG） to objectively evaluate sleep changes and exclude the impact of insomnia-related illnesses on the study. In other words,the accuracy of efficacy assessment needs to be improved.（4） The setting of curative effect assessment time,the existing studies mostly selected data before and after treatment to evaluate the data,and concentrated analysis of the immediate effect of acupoint and meridian stream method on the patient�

关 键 词：子午流注法 纳甲法 纳子法 养子时刻注穴法 失眠 时间疗法 

分 类 号：R224.3[医药卫生—中医基础理论]