基于《内经》“肌肉枯,气道涩”理论以健脾活血化痰法中药治疗老年失眠症的临床研究  

Clinical Study on the Treatment of Insomnia in the Elderly with the SpleenStrengthening,Blood-Activating and Phlegm-Resolving Chinese Herbal Medicine Based on the Theory of “Muscular Atrophy,Qi-Passage Blockage” Recorded in the Huang Di Nei Jing

作　　者：王朝 梅建强 闫赛强 张珣 刘澳 游晓艳 成立 WANG Chao;MEI Jian-Qiang;YAN Sai-Qiang;ZHANG Xun;LIU Ao;YOU Xiao-Yan;CHENG Li(Graduate School of Hebei University of Chinese Medicine,Shijiazhuang 050091 Hebei,China;The First Affiliated Hospital of Hebei University of Chinese Medicine,Shijiazhuang 050010 Hebei,China;People’s Hospital of Pingshan County,Shijiazhuang 050400 Hebei,China)

机构地区：[1]河北中医药大学研究生院,河北石家庄050091 [2]河北中医药大学第一附属医院,河北石家庄050010 [3]平山县人民医院,河北石家庄050400

出　　处：《广州中医药大学学报》2024年第7期1730-1737,共8页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家中医药管理局梅建强全国名中医药传承工作室建设项目(国中医药办人教函[2022]245号;国中医药办人教函[2022]75号);河北省中医药管理局科研计划项目(编号:2022021)。

摘　　要：【目的】探讨基于《黄帝内经》(简称《内经》)“肌肉枯,气道涩”理论,以健脾活血化痰法中药治疗老年失眠症的临床疗效。【方法】将120例老年失眠症患者随机分为观察组和对照组,每组各60例。对照组给予口服右佐匹克隆片治疗,观察组给予口服健脾活血化痰中药汤剂治疗,疗程均为4周。观察2组患者治疗前后匹兹堡睡眠质量指数(PSQI)评分、失眠严重程度指数(ISI)评分、多导睡眠图(PSG)相关参数[包括总睡眠时间(TST)、觉醒次数(AN)、睡眠潜伏期(SL)]、大脑动脉[包括大脑前动脉(ACA)、大脑中动脉(MCA)、大脑后动脉(PCA)]平均血流速度以及血清5-羟色胺(5-HT)、褪黑素(MT)水平的变化情况,并评价2组患者的临床疗效和安全性。【结果】(1)治疗4周后,观察组的总有效率为93.33%(56/60),略高于对照组的90.00%(54/60),但差异无统计学意义(P>0.05)。(2)治疗后,2组PSQI量表各项评分及总分均较治疗前降低(P<0.05),且观察组对睡眠质量、睡眠时间、睡眠效率、日间功能评分及总分的降低程度均明显优于对照组(P<0.05),而2组的入睡时间、睡眠障碍评分无显著性差异(P>0.05);停药4周后,观察组PSQI量表的各项评分均较治疗后继续降低(P<0.05),而对照组均无明显变化,差异均无统计学意义(P>0.05)。(3)治疗后,2组ISI评分均较治疗前降低(P<0.05),且观察组的降低程度明显优于对照组(P<0.05);停药4周后,观察组的ISI评分较治疗后继续下降(P<0.05),而对照组无明显变化,差异无统计学意义(P>0.05)。(4)治疗后,2组的TST、AN、SL等PSG相关参数均较治疗前改善(P<0.05),且观察组对TST及AN的改善程度均明显优于对照组(P<0.05)。(5)治疗后,观察组的ACA、MCA、PCA平均血流速度均较治疗前改善(P<0.05),而对照组均较治疗前无明显变化,差异均无统计学意义(P>0.05);组间比较,观察组对ACA、MCA、PCA平均血流速度的改善程度均明显优于对�Objective To explore the clinical efficacy of Chinese herbal medicine with the actions of invigorating spleen,activating blood and resolving phlegm in the treatment of senile insomnia based on the theory of “muscular atrophy,qi-passage blockage” recorded in Huang Di Nei Jing(The Yellow Emperor's Inner Classic,shortened as Nei Jing).Methods A total of 120 elderly patients with insomnia were randomly divided into observation group and control group,with 60 cases in each group.The control group was treated with oral use of Dexzopiclone Tablets,and the observation group was treated with oral use of decoction of Chinese herbal medicine for invigorating spleen,activating blood and resolving phlegm.The course of treatment covered 4 weeks.Before and after treatment,the two groups were observed in the changes of Pittsburgh Sleep Quality Index(PSQI) score,Insomnia Severity Index(ISI) score,polysomnography(PSG) related parameters of total sleep time(TST),number of awakenings(AN) and sleep latency(SL),mean blood flow velocity of anterior cerebral artery(ACA),middle cerebral artery(MCA),and posterior cerebral artery(PCA),and serum levels of 5-hydroxytryptamine(5-HT) and melatonin(MT).After treatment,the clinical efficacy and safety of the two groups were evaluated.Results(1) After 4 weeks of treatment,the total effective rate of the observation group was 93.33%(56/60),which was slightly higher than 90.00%(54/60) of the control group,but the difference was not statistically significant(P>0.05).(2) After treatment,the item scores and total scores of PSQI in the two groups were lower than those before treatment(P<0.05),and the decrease of the scores of sleep quality,sleep time,sleep efficiency,and daytime function as well as total scores in the observation group was significantly superior to that in the control group(P<0.05).However,there was no significant difference of time for falling asleep and sleep disorder scores between the two groups(P>0.05).After 4 weeks of drug withdrawal,the item scores of PSQI in the observation

关 键 词：“肌肉枯 气道涩”理论 老年失眠症 健脾活血化痰方 多导睡眠图 脑血流 5-羟色胺 褪黑素 

分 类 号：R256.23[医药卫生—中医内科学]