J. Acupunct. Tuina. Sci. 2010, 8 (1): 32-34 DOI: 10.

1007/s11726-010-0032-9

Special Topic Study

Clinical Observation of Electro-spoon Needle for Insomnia

ZHANG Xue-ling ()1, XING Yan-li ()2 1 Heilongjiang University of Traditional Chinese Medicine, Harbin 150040, P. R. China 2 The Second Hospital Affiliated to Heilongjiang University of Traditional Chinese Medicine, Harbin 150001, P. R. China

40 S1S2 S3S4 (P0.05) Abstract Objective: To observe the clinical effects of the electro-spoon needle on insomnia. Methods: Forty cases of insomnia were treated with the electro-spoon needle, and monitored with polysomnography to compare the difference of sleep pattern before and after treatment. Results: After treatment, the S1 stage of sleep was shorter, whereas, S2, S3, and S4 stages of sleep and rapid eye movement sleep were longer than those before treatment (P<0.05). Meanwhile, there was a significant difference in sleep pattern before and after treatment (P<0.05). Conclusion: Electro-spoon needle can improve the symptoms of insomnia. Key wordsInsomnia; Acupuncture Therapy; Spoon Needle CLC NumberR246.6 Document CodeA Insomnia refers to a sleep disorder syndrome that involves difficulty initiating and maintaining sleep and thus influences the daily activities. Sleep is very important for health. Insomnia is not a severe disorder, but can disturb normal learning, working and living. WHO declared in 2006 that the incidence of sleeping disorders reached 29% increasing annually. In China, the incidence of insomnia was 38% in adults[1]. The authors treated 40 cases of insomnia with the electro-spoon needle from September of 2007 to September of 2008, and the sleep was monitored with polysomnography. getting back to sleep, even sleeplessness throughout the night, accompanied with dizziness, headache, bad memory, and anxiety. Meanwhile, the Pittsburgh Sleep Quality Index (PSQI) was used to test sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, sleep medications and daytime function. Ones with above 10 points of PSQI were selected. 1.2 Exclusion criteria Secondary insomnia caused by physical diseases or mental disorders, dysfunction of heart, liver, or kidney, or other more severe diseases. 1.3 General data Forty cases were selected in out-patients from September of 2007 to September of 2008, including 12 males, and 28 females, aged from 18 to 70 years old, and disease duration between 6 months and 8 years.

1 Clinical Data
1.1 Diagnostic criteria It was based on the diagnostic criteria in the ICD-10 Classification of Mind and Behavior Disorder: Clinical Description and Key Point of Diagnosis. It manifested with difficulty falling asleep, or frequent waking, nightmares, difficulty
Author: ZHANG Xue-ling (1983- ), female, candidate for master degree

2 Therapeutic Methods
2.1 Needling methods Major acupoints: Sanyinjiao (SP 6), Neiguan (PC 6), and Shenmen (HT 7).

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J. Acupunct. Tuina. Sci. 2010, 8 (1): 32-34

Selecting acupoints based on syndrome differentiation: Xinshu (BL 15), and Pishu (BL 20) for heart-spleen deficiency; Xinshu (BL 15), Danshu (BL 19) and Qiuxu (GB 40) for heartgallbladder qi deficiency; Xinshu (BL 15), Shenshu (BL 23) and Taixi (KI 3) for excess fire due to yin deficiency; Ganshu (BL 18), Fengchi (GB 20), and Taichong (LR 3) for fire from liver stagnation; Zhongwan (CV 12) and Fenglong (ST 40) for inner disturbance of phlegm-heat. Operation: After the patient sat down, the acupoint was disinfected, and an electro-spoon needle (produced by Jointing Institute of Harbin, China) was inserted. The needle was retained for 30 min after qi arrival. The treatment was conducted daily for 30 d. 2.2 Monitoring methods of polysomnography Sleep was monitored before and after treatment. Patients lived in a shielded sleep room without disturbance, light, and noise, with room temperature of 18-22, humidity of 50%-70%, free flow of air, and a clean environment. All patients lived for two nights in the lab, one night for adaptation, and second night for monitoring. Embla N7000 polysomnography was employed. The sleep stage was scored according to A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects edited by Rechtschaffen and Kales[2]. The primary data were proofread manually after the auto-analysis. The monitoring period was from 21:00 to 7:00.

2.3 Main indexes Total time, sleep duration, total sleep time, sleep latency, waking time, and sleep efficiency. Sleep pattern including rapid eye movement (REM) sleep, non-rapid eye movement (NREM), and time of S1, S2, S3, and S4.

3 Therapeutic Effects
3.1 Statistical analysis Measurement data were analyzed with t test, and enumeration data with Chi-square test in SPSS. 3.2 Results 3.2.1 Comparison of sleep Pre- and post-treatment After treatment, the latent period of sleep was shorter, and the total sleep time and sleep efficiency was more than that before treatments (P<0.05, table 1).
Table 1. Comparison of sleep before and after treatment ( x s) Time n Sleep Latency (min)
1)

Total sleep time (min) 297.4841.94 382.7265.75

1)

Sleep efficiency (%) 61.3610.45 79.2414.27 1)

Pre-treatment 40 48.1724.25 Post-treatment 40 23.3612.31

Note: Compared with that before treatment, 1) P0.05.

3.2.2 Comparison of sleep pattern before and after treatment After treatment, the S1, S2, S3, and S4 stages of sleep and REM sleep stage were better than they were before treatments (P<0.05, table 2).

Table 2. Comparison of sleep pattern before and after treatment ( x s, min) Time Pre-treatment Post-treatment n 40 40 S1 35.169.13 24.275.26 1) S2 215.8359.51 182.4642.94 S3 15.525.85 25.6310.25 S4 13.745.21 26.569.65 REM 51.7021.43 87.5722.56

Note: Compared with that before treatment, 1) P0.05

4 Discussion
The analyzing methods of polysomnography were based on methods of Rechtschaffen and Kales[2]. Patients with insomnia have not only bad sleep quality, but conflicting subjective and objective evaluation. Subjective evaluation of sleep latency, total sleep time, and sleep efficiency were inconsistent with the evaluation of polysomnography[3].

In adults, S1 stage accounts for 5%-10%, S2 stage for 50%, S3 stage for 10%-20%, S4 stage for 10%-20%, and REM for 20%-25% in the total sleep time. Every stage has relative ratio, and forms 4-6 circles of NREM-REM[4]. In the present study, after treatment, patients sleep latency, total sleep time, and sleep efficiency were improved (P<0.05), and the S1 and S2 stages of sleep were shorter, whereas, S3, and S4 stages of sleep and REM sleep stage were longer than those before treatment (P<0.05).

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J. Acupunct. Tuina. Sci. 2010, 8 (1): 32-34

In addition, waking times were fewer. All these indicated that the sleep latency was shorter, light sleep was less, deep sleep increased, and the sleep quality had improved. Insomnia belongs to the category of sleeplessness. Wei-Defensive yang travels in the Yang Heel Vessel during the day and in the Yin Heel Vessel at night. If the Wei-Defensive yang is in excess in the Yang Heel Vessel, and the Ying-Nutritive yin is deficient in the Yin Heel Vessel, Wei-Defensive yang will not link with the Ying-Nutritive yin, leading to insomnia. Xinshu (BL 15) and Pishu (BL 20) were used for heart-spleen deficiency to tonify qi and blood, and benefit heart and spleen; Xinshu (BL 15), Danshu (BL 19), and Qiuxu (GB 40) for heart-gallbladder qi deficiency to tonify heart and gallbladder, and soothe the mind; Xinshu (BL 15), Shenshu (BL 23), and Taixi (KI 3) for excess fire from yin deficiency to nourish yin, calm down the fire, soothe the heart and mind; Ganshu (BL 18), Fengchi (GB 20), and Taichong (LI 3) for fire from liver stagnation to calm liver and fire, relieve stagnation, and soothe the mind; Zhongwan (CV 12), and Fenglong (ST 40) for inner disturbance of phlegm-heat to clear heat, reduce phlegm, harmonize stomach, and soothe the mind. The electro-spoon needle was developed based on spoon needle and electroacupuncture in traditional Chinese medicine. Electroacupuncture has been effective in treating insomnia[5,6]. Spoon needle could regulate Ying-Nutritive qi and Wei-Defensive qi, nourish qi and blood, and improve the functions

of the Zang-fu organs. Dissipating the excess qi, and tonifying the deficient qi can harmonize qi and blood, balance yin and yang, and soothe the mind, therefore, insomnia could be treated. Many years of clinical experience have confirmed that the electro-spoon needle treatment has a similar effect to routine needling methods without being painful, and without any negative side-effects affecting therapeutic results, so, patients accept and welcome this method.

References
[1] LI Mei. Research Progress of Traditional Chinese Medicine on Insomnia. Journal of Liaoning Universtity of Traditional Chinese Medicine, 2008, 10(5): 51-52. [2] Rechtschaffen A, Kales A. A manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. Losangeles: Brain Research Institute, University of California, 1977: 1-12. [3] LI Chong, JIA Fu-jun, TAN Chun-ying, et al. Comparing Analysis of Subjective Evaluation and Polysomnography in Insomnia Patients. Chinese Mental Health Journal, 2000, 14(3): 212-214. [4] TAN Yu-ling. Clinical Electroencephalogram and Brain Electrical Activity Mapping. Beijing: Peoples Medical Publishing House, 1999: 58. [5] ZHU Shao-hua. Electroacupuncture on Insomnia. Shanxi Journal of Traditional Chinese Medicine, 2007, 23(3): 6-7. [6] GUO Yuan-qi, ZHENG Guan-en, CHEN Li-yi, et al. Treatment of 106 Cases of Insomnia with Electroacupuncture. Shanghai Journal of Acupuncture and Moxibustion, 2001, 20(2): 25. Translator: CUI Xue-jun () Received Date: October 16, 2009

Advance Notice

Main Contents of the Second Issue in 2010

Clinical Study on the Effects of Acupuncture Combination with Psychological Desensitization Therapy for Treatment of the Anxiety with the Heroin Addicts Clinical Observation on Treatment of Seasonal Allergic Rhinitis with Warm Needling Moxibustion Influences of Acupuncture and Moxibustion on Peripheral Blood Cytokine in Patients with Perennial Allergic Rhinitis Clinical Observation on the treatment of Allergic Rhinitis with External Application after Plum-blossom Needle Tapping

34 Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2010