Abstract: Background　Chronic insomnia affects people's work and life，increases the risk of having disease，reduces work efficiency of patients and causes huge losses of accidents.At present，benzodiazepines are still the main treatment for chronic insomnia.Long-term and high-dose use of benzodiazepines will significantly reduce the responsiveness of these drugs.As human organs can affect people's spirit，viscera function disorder can lead to insomnia.Acupuncturing on Wuzangshu acupoint can adjust Yin and Yang and viscera function.Objective　To investigate the clinical efficacy of acupuncture at Wuzangshu combined Geshu acupoints with fire needles and filiform needles in the treatment of chronic insomnia.Methods　We enrolled 60 cases of chronic insomnia treated in Beijing Shunyi District Hospital of Traditional Chinese Medicine from November 2016 to October 2017，and divided them into fire needle group （n=30） and filiform needle group （n=30） based on the random number table.Both groups received treatment of acupuncture at Baihui，Sishencong，Shenmen，Sanyinjiao and other acupoints with filiform needles，once daily，5 times a week，the fire needle group additionally received acupuncture at Wuzangshu combined Geshu acupoints with fire needles （developed by HE Pu-ren），once every other day，3 times a week.The duration of treatment for both groups was 4 weeks.The clinical response was evaluated at the end of treatment and 1 month after the end of treatment by the Pittsburgh Sleep Quality Index （PSQI），Zung Self-Rating Anxiety Scale （SAS） score，and Zung Self-Rating Depression Scale （SDS） score.Results　 In the fire needle group，7，12，9，2 showed complete，marked，effective，and ineffective clinical response，respectively，while in the filiform needle group，3，9，11，7 showed complete，marked，effective，and ineffective clinical response，respectively，indicating that the former had better clinical response （Z=-2.152，P=0.031）． There was an interaction between treatment method and duration on total PSQI score，SAS score，SDS score （P<0.05）． Treatment method produced significant main effects on total PSQI score，SAS score，and SDS score （P<0.05），so did the treatment duration.Total PSQI score，SAS score，and SDS score were similar in both groups before treatment，but they decreased significantly in the fire needle group at the end of treatment and 1 month after the end of treatment（P<0.05）． PSQI score，SAS score，and SDS score in the fire needle group at the end of treatment and 1 month after the end of treatment declined significantly compared with baseline （P<0.05）． Conclusion　For chronic insomnia，acupuncture at Baihui，Sishencong，Shenmen，Sanyinjiao and other acupoints with filiform needles was inferior to its combination with acupuncture at Wuzangshu combined Geshu acupoints with fire needles and filiform needles.

Key words: Insomnia, Fire-needle therapy, Filliform needle, Comparative effectiveness research

摘要： 背景　慢性失眠症影响人们的工作和生活，增加罹患疾病的风险，降低患者工作效率以及引发意外事故造成巨大损失。目前对于慢性失眠症治疗仍以苯二氮卓类药物为主，长期大剂量使用会出现对此类药物反应性下降。五脏藏神，人的精神情志与五脏密切相关，五脏失调可以导致失眠，通过针刺五脏俞可以调和阴阳、调整脏腑功能。目的　探讨火针五脏俞加膈俞配合毫针治疗慢性失眠症的临床疗效。方法　选取2016年11月—2017年10月北京中医医院顺义医院针灸科收治的60例慢性失眠症患者为研究对象，采用随机数字表法分为火针组和毫针组，各30例。毫针组给予毫针针刺百会、四神聪、神门、三阴交等穴，1次/d，5次/周；火针组在毫针组基础上选取双侧五脏俞加膈俞，予贺氏火针点刺，隔日治疗1次，3次/周；两组均连续治疗4周。评定两组临床疗效，分别于治疗前、治疗4周时及治疗结束后1个月进行匹兹堡睡眠质量指数（PSQI）评分、焦虑自评量表（SAS）评分和抑郁自评量表（SDS）评分。结果　治疗后，火针组临床痊愈7例、显效12例、有效9例、无效2例；毫针组临床痊愈3例、显效9例、有效11例、无效7例；火针组临床疗效优于毫针组（Z=-2.152，P=0.031）。治疗方法与时间在PSQI评分、SAS评分、SDS评分上存在交互作用（P<0.05），治疗方法在PSQI评分、SAS评分、SDS评分上主效应显著（P<0.05），时间在PSQI评分、SAS评分、SDS评分上主效应显著（P<0.05）。其中治疗前两组患者PSQI评分、SAS评分、SDS评分比较，差异无统计学意义（P>0.05）；治疗4周及治疗结束后1个月火针组PSQI评分、SAS评分、SDS评分较毫针组降低（P<0.05）。火针组和毫针组治疗4周及治疗结束后1个月PSQI评分、SAS评分、SDS评分较治疗前降低（P<0.05）。结论　火针五脏俞加膈俞配合毫针针刺治疗能更有效地改善慢性失眠症患者的睡眠质量，临床疗效优于单纯毫针治疗。

关键词: 失眠症, 火针疗法, 毫针, 疗效比较研究