Scholarly article on topic 'Acupuncture plus Cupping for Treating Insomnia in College Students'

Acupuncture plus Cupping for Treating Insomnia in College Students Academic research paper on "Clinical medicine"

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{insomnia / sleep / acupuncture / "moving cupping up and down" / "college student"}

Abstract of research paper on Clinical medicine, author of scientific article — Yue-feng ZHANG, Gui-fang REN, Xiu-chun ZHANG

Objective To observe clinical therapeutic effect of acupuncture plus cupping for treating insomnia in college students. Methods Ninety two college students suffering from insomnia were randomly divided into a treatment group (52 cases) and a control group (40 cases). Acupuncture plus cupping was used for profiting the brain and tranquilizing the mind in the treatment group, and conventional differentiation of symptoms and signs was used in the control group. Therapeutic effect, number of treatment, self-rating sleeping scaling (SRSS), and subtracted rate were evaluated after one month of treatment. Results There was a significant difference in effective rate between the two groups (P<0.05). For the cases with moderate insomnia, the effective rate was obviously better in the treatment group than that in the control group (P<0.05), and for the cases with slight and moderate insomnia, the average treatment number was remarkably less in the former than that in the latter (P<0.01). SRSS was reduced in both groups (P<0.01, P<0.05) with a significant difference between the two groups (P<0.05). The subtracted rate in the former was more than that in the latter (P<0.05). Conclusion The therapeutic effect in the treatment group was better than that in the control group, showing superiority in the cases with moderate insomnia with less treatments and more improved and cured rates.

Academic research paper on topic "Acupuncture plus Cupping for Treating Insomnia in College Students"

Acupuncture plus Cupping for Treating Insomnia in College Students

ZHANG Yue-feng REN Gui-fang -fi^ & ZHANG Xiu-chun

Hospital of Liaocheng University, Liaocheng, Shandong 252059, China

Objective: To observe clinical therapeutic effect of acupuncture plus cupping for treating insomnia in college students. Methods: Ninety two college students suffering from insomnia were randomly divided into a treatment group (52 cases) and a control group (40 cases). Acupuncture plus cupping was used for profiting the brain and tranquilizing the mind in the treatment group, and conventional differentiation of symptoms and signs was used in the control group. Therapeutic effect, number of treatment, self-rating sleeping scaling (SRSS), and subtracted rate were evaluated after one month of treatment. Results: There was a significant difference in effective rate between the two groups (P<0.05). For the cases with moderate insomnia, the effective rate was obviously better in the treatment group than that in the control group (P<0.05), and for the cases with slight and moderate insomnia, the average treatment number was remarkably less in the former than that in the latter (P<0.01). SRSS was reduced in both groups (P<0.01, P<0.05) with a significant difference between the two groups (P<0.05). The subtracted rate in the former was more than that in the latter (P<0.05). Conclusion: The therapeutic effect in the treatment group was better than that in the control group, showing superiority in the cases with moderate insomnia with less treatments and more improved and cured rates.

Key words: insomnia; sleep; acupuncture; moving cupping up and down; college student

Insomnia is a sleeping disorder most commonly encountered. According to investigation, 43.8% of general people do not have good sleep with college students ranking at the first in insomnia severity among the population including middle school students, employees and soldiers.1'2 Therefore, college students suffering from insomnia are the very crowd that needs to be paid close attention. Emphasizing the principle of profiting the brain and tranquilizing the mind, the authors have treated 52 cases of college students suffering from insomnia by acupuncture plus cupping. It is reported as follows.

CLINICAL MATERIALS General Data

Ninety two college students suffering from insomnia were all from the clinic of Hospital of Liaocheng University. They were randomly divided into a treatment group (52 cases) and a control group (40 cases). Of the 52 cases in the treatment group, 28

cases were male and 24 cases female, ranging in age from 19 to 25 years (mean 22.3 years), and in course of disease from 1 month to 5 years (mean 29.6 months). Of the 40 cases in the treatment group, 21 cases were male and 19 cases female, ranging in age from 18 to 25 years (mean 21.9 years), and in course of disease from 1.5 months to 5 years (mean 27.8 months). No cases had been treated by sleeping pills. There was no significant difference in gender, age, course of disease and severity (P>0.05) between the two groups, showing they were comparable.

Criteria for Diagnosis

Grading was made according to both the Criteria for Insomnia included in Chinese Classification and Criteria for Mental Diseases (the 3rd edition) and the Self-rating sleeping situation scaling (SRSS) established by LI Jian-ming.3 In SRSS, 10 items were

This study was supported by a grant from Scientific Research Project of Liaocheng University (X051024)

included, and each was estimated as 1 to 5 grades and as 10 to 50 scores representing the increasing severity of sleeping problem. According to LI Jian-ming's criteria, the cases with scores being <22 were evaluated as the cases with normal sleeping situation, those being 23-29 as with mild sleeping disorder, those being 30-39 as with moderate sleeping disorder, and those being 40-50 as with severe sleeping disorder.4

Criteria for Case Inclusion

The cases that in accord with the criteria for insomnia mentioned above with sleeping scores (SRSS including 10 items) being >22 without history of severe systemic disease, alcoholic nor drug dependence were included in this observation.

METHODS

Treatment Group

Profiting the brain and tranquilizing the mind were taken as the principle for treatment. Baihui (GV 20), Shangxing (GV 23), Yintang (EX-HN3), Neiguan (PC 6), Shenmen (HT 7), Zusanli (ST 36), Sanyinjiao (SP 6) and Taichong (LR 3) were selected. Filiform needles of 25 mm and 40 mm in length and 0.25 in diameter were used to insert backward and transcutaneously into Shangxing (GV 23) and Baihui (GV 20) to the depth of 13-20 mm, and the needles were rotated for reinforcing to produce local distending sensation. For Yintang (EX-HN3), a needle was transcutaneously inserted toward the root of nose to the depth of 13-20 mm, and a rotating maneuver for reducing was used to cause local soreness. For Neiguan (PC 6), a needle was perpendicularly inserted to the depth of 13-20 mm, and a rotating maneuver for reducing was used to cause local soreness or electrical stimulation radiating to the middle finger. For Sanyinjiao (SP 6) and Zusanli (ST 36), needles were perpendicularly inserted to the depth of 20-30 mm, and a rotating maneuver for reinforcing was used to cause local soreness. For Shenmen (HT 7), a needle was perpendicularly inserted to the depth of 13-20 mm, and a rotating maneuver for reinforcing was used to cause local soreness. For Taichong (LR 3), a needle

was perpendicularly inserted to the depth of 13-20 mm, and a rotating maneuver for reinforcing was used to cause local soreness. The needles remained for 30 minutes, and the treatment was given once daily for consecutive 6 days weekly with one day off each week. Moving cupping up and down was applied in the following way: with couplant smeared on the back, cupping after flash of fire was made along bilateral side of the spinal column by evenly moving cupping up and down to cause appearance of atropurpureus dots. The treatment was given once every other day with 3 times weekly.

Control Group

The patients were differentiated into four syndromes based on their symptoms, tongue and pulse manifestations.5 For the cases with the heart and spleen deficiency, Pishu (BL 20), Xinshu (BL 15), Shenmen (HT 7) and Sanyinjiao (SP 6) were selected; For those with hyperactivity of fire due to yin deficiency, Daling (PC 7), Taixi (KI 3), Shenmen (HT 7) and Taichong (LR 3) were selected; For those with disturbance of the stomach, Zhongwan (CV 12), Fenglong (ST 40), Lidui (ST 45) and Yinbai (SP 1) were selected; For those with liver-fire disturbing upward, Xingjian (LR 2), Zuqiaoyin (GB 44), Fengchi (GB 20) and Shenmen (HT 7) were selected. Point prescriptions were modified according to symptoms. A reinforcing maneuver was mainly used for the cases with deficiency and a reinforcing maneuver used for those with excess. The way of moving cupping up and down was similar to that applied in the treatment group.

Criteria for Therapeutic Effect

According to the Standard for Diagnosis of Diseases and Therapeutic Effects for insomnia in TCM set by the State Administration of Traditional Chinese Medicine, normal sleep with disappearance of insomnia was evaluated as cured, prolonged sleep duration with alleviated insomnia evaluated as improved, and no alleviation of insomnia evaluated as failed. Treatment numbers, SRSS scores, and decreased rate calculated by ((scores before treatment - scores after treatment) / scores before treatment x 100%) were taken as assisted indices for observation.

Statistical Analysis

SPSS12.0 software was used for statistical analysis. Comparison of rates was made by x test, that of non-numerical indices for independent sample made by rank-sum test, that of quantities before and after treatment made by pared t-test, and that of

independent samples among groups made by t-test.

RESULTS Comparison of Therapeutic Effect

Comparison of total effective rate and treatment

numbers of two groups are shown in Table 1.

Table 1. Comparison of therapeutic effect and treatment numbers

Group Severity Cases Treatment Number Cured Improved Failed Effective Rate

Treatment Mild 13 8.6** 13 - - 100%

Moderate 35 15.2** 26 7 2 94.29%

Severe 4 26 1 1 2 50%

Sum 52 11.6** 40 8 4 92.31%*

Control Mild 9 12.9 8 1 - 100%

Moderate 28 20.8 13 9 6 78.57%

Severe 3 26 - 1 2 33.33%

Sum 40 19.4 21 11 8 80.00%

Notes: *P< 0.05; **P<0.01, compared with the control group.

There was a significant difference in effective rate between the two groups (P<0.05). In terms of severity, for the cases with mild insomnia, the effective rate was 100% for both groups (P>0.05), for the cases with moderate insomnia, the effective rate was obviously better in the treatment group than that in the control group (P<0.05). Cases with severe insomnia were not enough for statistical analysis, but there was a tendency that the effective rate in the former group was better than that in the latter. For the

cases with mild and moderate insomnia, the average treatment number was remarkably less in the former than that in the latter (P<0.01). Comparison of SRSS and Subtracted Rate SRSS was very significantly reduced in the treatment group (P<0.01) and significantly reduced in the control group (P<0.05) with a significant difference between the two groups (P<0.05). The difference in subtracted rate between the two groups was of significance (Table 2).

Table 2. Comparison of SRSS and subtracted rate

Group Cases Before After Subtracted Rate

Treatment 52 31.54±3.62 21.31±3.16*** 32.40%*

Control 40 32.61±3.73 24.56±3.21* 24.15%

Notes: *P< 0.05; **P<0.01, compared before and after treatment; *P<0.05, compared with the control group.

TYPICAL CASE

A college student in grade 4, aged 22, paid his first visit on November 26, 2006. He suffered from insomnia with difficulty in falling asleep, light sleep and early waking up with gradual reduced sleep duration from 7 hours to 3 hours each night due to strong stress caused by preparing examinations for

entrance of post-graduate study. In the recent one week, he could hardly fall asleep until about 3 o'clock before dawn, for which he complained of being exhausted and depressed with difficulty in thinking, with slow reaction, inattention and descending memory, even loss of confidence for study and entrance examination for post-graduate

study. By SRSS, he was evaluated to have 36 scores. He was then treated by acupuncture at Baihui (GV 20), Shangxing (GV 23), Yintang (EX-HN3), Neiguan (PC 6), Shenmen (HT 7), Zusanli (ST 36), Sanyinjiao (SP 6) and Taichong (LR 3). The needles were retained for 30 minutes, during which the needle manipulation was made once every 5 minutes, and the treatment was given once daily. In addition, moving cupping was applied on the back, which was given once every other day. After the first treatment, he could fall asleep with obvious improvement. After 3 treatments his sleep was normalized, and he could even fall asleep faster than before insomnia occurrence with about 7-hour sound sleep. With disappearance of insomnia, he felt full of spirit for study. Continuous 3 treatments were given for solidifying the therapeutic effect. A follow-up made 1 month later showed that he had had good sleep only with occasional difficulty, in which he needed 30-60 minutes to fall asleep with 15 scores in SRSS, for which he was evaluated as clinically cured.

DISCUSSION

The ultimate pathological turnover of insomnia, no matter it is of deficiency or excess, is of restlessness. Excess-induced insomnia is caused by disturbance of mental activities, and deficiency-induced insomnia caused by hypofunction of mental activities. For treating the disease, profiting the brain and tranquilizing the mind should be stressed and taken as fundamental aspect. In the present observation, points were selected based on the second main group of points for inducing resuscitation, in which some points were omitted and Shenmen (HT 7), Zusanli (ST 36) and Taichong (LR 3) were added.6 Since the cause and pathogenesis of insomnia are different to those of apoplexy, needling manipulation should be different. The maneuver for inducing resuscitation was harsh, but lenitive for insomnia. Both Shangxing (GV 23) and Baihui (GV 20) belong to the Governor Vessel, which runs into the brain, and gets to the vertex to converge with the Liver Meridian. It is connected with the Conception Vessel, and it origins from the same place as both Conception and Chong Vessels. Therefore, acupuncture at Shangxing (GV 23)

and Baihui (GV 20) can regulate yin and yang, replenish essence and tonify marrow, so as to profit the brain and tranquilize the mind. Pertaining to Extraordinary Meridians, Yintang (EX-HN3) is located in the cranial-facial region and in the pathway of the Governor Vessel, and it can be used to open the orifice and activate mental activity. As the connecting point of the Pericardium Meridian of Hand-Jueyin, it can be used to tranquilize mind by nourishing the heart and promote flow of qi and blood. Being the convergent point of three meridians, the Spleen Meridian of Foot-Taiyin, the Liver Meridian of Foot-Jueyin and the Kidney Meridian of Foot-Shaoyin, Sanyinjiao (SP 6) can be used to replenish yin, tonify the kidney and produce marrow. The brain is the sea containing marrow, and sufficient narrow is beneficial to the brain. Needling Shenmen (HT 7) can make tranquilization by calming the mind and relieving depression. Needling Taichong (LR 3) can soothe the liver and regulate the flow of qi to remove depression. Acupuncture at Zusanli (ST 36) can also be used to treat insomnia of various types to make tranquilization and allay excitement in addition to nourishing qi and blood.8 Besides, moving cupping can stimulate the Bladder Meridian and Jiaji points to regulate the functions of zang and fu organs and provide tranquilization and allay excitement.

Most college students with insomnia were in moderate severity with a history of 1-5 years. In some cases, insomnia started to bother them when they were in middle schools, but usually they neglect it without any treatment. Most cases stopped their treatment by themselves when they felt better without accepting doctors' advice for continuous treatment, and they could hardly insist on sufficient treatment for strengthening curative effects. Therefore, treatment numbers given were limited in both groups. If enough treatments were given, better therapeutic effect would be achieved.

REFERENCES

1. Wang G, Zhang JX, Xu YY, et al. Current situation of sleeping quality in general population. J of Health Psychology 2002; 10: 430-432.

2. Li JM, Chen J, Yin SF et al. Investigation on sleeping situation in people with various jobs. J of Health Psychology 2000; 8: 596-600.

3. Li JM. Self-rating sleeping scaling (SRSS). J of Health Psychology 2000; 8: 353-354.

4. Li JM, Yin SF, Duan JX, et al. An analysis on sleeping situation in 13273 normal subjects estimated by SRSS. J of Health Psychology 2000; 8: 351-353.

5. Yang CS. Acupuncture and Moxibustion Therapeutics. Shanghai: Shanghai Science and Technological Pub-

lishing House; 1985: 65-66.

6. Shen XM. Sleeping of Children and Their Sleeping Didorder. Beijing: People's Medical Publishing House; 2002: 11.

7. Lian YL. Working Wonders of 100 Important Points in Chinese Acupuncture and Moxibustion. Huhehaote: Neimenggu Science and Technological Publishing House; 2003: 41, 268.

(Translated by CHEN Zheng-qiu

Received September 26, 2009