Efficacy and Mechanism of Action of Wuyintiaoshen Therapy in Patients with Post-stroke Insomnia

doi:10.12114/j.issn.1007-9572.2021.02.101

Chinese General Practice ›› 2022, Vol. 25 ›› Issue (12): 1475-1481.DOI: 10.12114/j.issn.1007-9572.2021.02.101

Special Issue: 神经系统疾病最新文章合辑；脑健康最新研究合辑

• Original Research·Characteristic Therapy of TCM • Previous Articles Next Articles

Efficacy and Mechanism of Action of Wuyintiaoshen Therapy in Patients with Post-stroke Insomnia

¹Neck Shoulder and Lumbago Pain Hospital Affiliated to Shandong First Medical University, Jinan 250012, China
²The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250001, China
³Shandong University of Traditional Chinese Medicine, Jinan 250355, China

Received:2021-07-20 Revised:2021-10-09 Published:2022-02-17 Online:2022-03-21
Contact: Yi DING
About author:
GUO C C, LU H F, ZHUANG H, et al. Efficacy and mechanism of action of Wuyintiaoshen therapy in patients with post-stroke insomnia [J] . Chinese General Practice, 2022, 25 (12) : 1475-1481.

"五音调神"法治疗卒中后失眠的临床疗效及机制研究

¹250012　山东省济南市，山东第一医科大学附属颈肩腰腿痛医院
²250001　山东省济南市，山东中医药大学第二附属医院
³250355　山东省济南市，山东中医药大学

通讯作者: 丁懿
作者简介:
郭琛琛，鹿海峰，庄贺，等."五音调神"法治疗卒中后失眠的临床疗效及机制研究[J].中国全科医学，2022，25（12）：1475-1481. [www.chinagp.net] 作者贡献：郭琛琛进行研究的实施与可行性分析，数据收集，结果的分析与解释，撰写论文；丁懿进行文章的构思与设计，统计学处理；王从安进行数据整理；鹿海峰进行论文的修订；庄贺负责文章的质量控制及审校；李丽对文章整体负责，监督管理。
基金资助:
国家重点研发计划项目(2018YFC1706005); 山东省医药卫生发展计划项目(202020010789)

Abstract

Abstract:

Background

Insomnia is a common post-stroke complication, which may greatly influence patients' recovery progress, and even induce the recurrence of cerebrovascular diseases. It has been reported that the traditional Wuyintiaoshen therapy has good efficacy in post-stroke insomnia, and can decrease the harm of adverse reactions often produced by western medicine treatment via reducing the intake of such medicines.

Objective

To explore the clinical effect and possible mechanism of action of Wuyintiaoshen therapy on post-stroke insomnia.

Methods

Post-stroke insomnia inpatients (n=90) were selected from Rehabilitation Department, the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2019 to June 2020, and equally randomized into an experimental group and a control group. Besides usual rehabilitation training and basic medical treatment, experimental group received Wuyintiaoshen therapy〔listening to the music symbolizing the five elements (metal, wood, water, fire, and earth) in Chinese philosophy〕 plus acupuncture treatment with Baihui, Shenting, and Yintang acupoints, and the control group received oral alprazolam before sleeping. The treatment for all patients was 4 weeks. Clinical efficacy was evaluated by comparing pre- and post-treatment changes in sleep quality assessed using Pittsburgh Sleep Quality Index (PSQI) , quality of life assessed using Stroke-specific Quality of Life Scale (SS-QOL) , and sensorimotor impairment using Fugl-Meyer Assessment Scale (FMA) , as well as levels of serum 5-HT, melatonin and norepinephrine. Adverse reactions were observed during treatment.

Results

There was no significant difference in overall clinical efficacy between the two groups (P>0.05) . The incidence of adverse reactions was higher in the control group (P<0.05) . The PSQI, SS-QOL and FMA scores as well as serum levels of 5-HT, melatonin and norepinephrine were similar in both groups before and after treatment (P>0.05) . After treatment, the PSQI score and norepinephrine level decreased, and SS-QOL and FMA scores as well as serum levels of 5-HT and melatonin increased in both groups (P<0.05) , but were still similar in both groups (P>0.05) . Correlation analysis results showed that PSQI score was negatively correlated with SS-QOL or FMA score (r=-0.340, P=0.010; r=-0.350, P=0.008) .

Conclusion

Wuyintiaoshen therapy may produce good effects on post-stroke insomnia as an adjuvant therapy, which were similar to those of oral alprazolam, the mechanism may be related to the regulation of serum 5-HT, melatonin and norepinephrine, and sleep quality improvement had a direct linear relationship with motor function and life quality improvement.

Key words: Stroke, Sleep initiation and maintenance disorders, Post-stroke insomnia, Wuyintiaoshen therapy, Serotonin, Melatonin, Norepinephrine

摘要：

背景

卒中后失眠（PSI）是卒中后常见并发症，严重影响患者康复进度，甚至引起脑血管疾病的复发。而西药治疗常出现不良反应，传统中医外治法"五音调神"可减少药物的摄入，减轻对身体的危害，其临床疗效较为显著。

目的

探究"五音调神"法对PSI的临床治疗效果，并分析其可能的作用机制。

方法

选取2019年1月至2020年6月在山东中医药大学第二附属医院康复科住院的PSI患者90例为研究对象，采用随机数字表法将其分为试验组和对照组，各45例。患者均进行常规的康复训练和内科基础治疗。试验组干预方法为：聆听五行音乐结合针刺百会、神庭、印堂；对照组干预方法为：睡前30 min口服阿普唑仑片，两组均连续治疗4周。观察两组临床疗效和不良反应发生情况。并在治疗前、后分别采用匹兹堡睡眠质量指数量表（PSQI）、脑卒中专用生活质量量表（SS-QOL）和Fugl-Meyer量表进行评定，检测血清5-羟色胺（5-HT）、褪黑素（MT）及去甲肾上腺素（NE）水平。

结果

两组临床疗效比较，差异无统计学意义（P>0.05）。对照组不良反应发生率高于试验组（P<0.05）。治疗前、后，两组PSQI、SS-QOL、Fugl-Meyer评分以及血清5-HT、MT、NE水平比较，差异均无统计学意义（P>0.05）。两组治疗后PSQI评分、NE水平均低于同组治疗前，SS-QOL、Fugl-Meyer评分，血清5-HT、MT水平均高于同组治疗前（P<0.05）。相关性分析结果显示，SS-QOL、Fugl-Meyer评分与PSQI评分均呈负相关（r=-0.340，P=0.010；r=-0.350，P=0.008）。

结论

"五音调神"法可以有效治疗PSI，能够达到与口服阿普唑仑相近的效果，其机制可能是与调节血清5-HT、MT、NE水平有关，且睡眠质量的改善程度与运动功能提高、生活质量改善程度均存在直接线性关系。

关键词: 卒中, 入睡和睡眠障碍, 卒中后失眠, "五音调神"法, 血清素, 褪黑素, 去甲肾上腺素

Chenchen GUO,Haifeng LU,He ZHUANG, et al. Efficacy and Mechanism of Action of Wuyintiaoshen Therapy in Patients with Post-stroke Insomnia[J]. Chinese General Practice, 2022, 25(12): 1475-1481. DOI: 10.12114/j.issn.1007-9572.2021.02.101.
郭琛琛,鹿海峰,庄贺等. "五音调神"法治疗卒中后失眠的临床疗效及机制研究[J]. 中国全科医学, 2022, 25(12): 1475-1481. DOI: 10.12114/j.issn.1007-9572.2021.02.101.

Figures/Tables 6

References 31

[1]	LEPPÄVUORI A, POHJASVAARA T, VATAJA R，et al. Insomnia in ischemic stroke patients[J]. Cerebrovasc Dis，2002，14(2)：90-97. DOI：10.1159/000064737.
[2]	HERMANN D M, SICCOLI M, BRUGGER P，et al. Evolution of neurological，neuropsychological and sleep-wake disturbances after paramedian thalamic stroke[J]. Stroke，2008，39(1)：62-68. DOI：10.1161/strokeaha.107.494955.
[3]	李泰标. 针刺治疗脑卒中后失眠疗效观察[J]. 中国康复理论与实践，2007，13(7)：656-657.
[4]	SCHUILING W J, RINKEL G J, WALCHENBACH R，et al. Disorders of sleep and wake in patients after subarachnoid hemorrhage[J]. Stroke，2005，36(3)：578-582. DOI：10.1161/01.STR.0000154862.33213.73.
[5]	中华医学会神经病学分会，中华医学会神经病学分会睡眠障碍学组. 中国成人失眠诊断与治疗指南（2017版）[J]. 中华神经科杂志，2018，51(5)：324-335. DOI：10.3760/cma.j.issn.1006-7876.2018.05.002.
[6]	LEE S H, LIM S M. Acupuncture for insomnia after stroke：a systematic review and meta-analysis[J]. BMC Complement Altern Med，2016，16：228. DOI：10.1186/s12906-016-1220-z.
[7]	SARRIS J, BYRNE G J. A systematic review of insomnia and complementary medicine[J]. Sleep Med Rev，2011，15(2)：99-106. DOI：10.1016/j.smrv.2010.04.001.
[8]	中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南（2018）[J]. 中华神经科杂志，2018，51(9)：666-682. DOI：10.3760/cma.j.issn.1006-7876.2018.09.004.
[9]	中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南（2019）[J]. 中华神经科杂志，2019，52(12)：994-1005. DOI：10.3760/cma.j.issn.1006-7876.2019.12.003.
[10]	American Academy of Sleep Medicine. International classification of sleep disorders，3rd edition[M]. Darien IL：American Academy of Sleep Medicine，2014.
[11]	国家中医药管理局. 中医病证诊断疗效标准[S]. 北京：国家中医药管理局，1994.
[12]	中华医学会神经病学分会，中华医学会神经病学分会神经康复学组，中华医学会神经病学分会脑血管病学组.中国脑卒中早期康复治疗指南[J].中华神经科杂志，2017，50(6)：405-412. DOI：10.3760/cma.j.issn.1006-7876.2017.06.002.
[13]	ZHANG S, CHANG C, ZHANG J，et al. Correlation analysis of sleep quality and youth ischemic stroke[J]. Behav Neurol，2014，2014：246841. DOI：10.1155/2014/246841.
[14]	刘志喜，石倩萍，杨洪霞，等. 匹兹堡睡眠质量指数量表在护理人群中的信效度评价[J]. 汕头大学医学院学报，2020，33(3)：173-176. DOI：10.13401/j.cnki.jsumc.2020.03.011.
[15]	WILLIAMS L S, WEINBERGER M, HARRIS L E，et al. Development of a stroke-specific quality of life scale[J]. Stroke，1999，30(7)：1362-1369. DOI：10.1161/01.str.30.7.1362.
[16]	李军涛，王伊龙，于进洪，等. 脑卒中专门化生存质量量表（SS-QOL）中译本在冀南地区效度的研究[J]. 脑与神经疾病杂志，2007，15(3)：177-179.
[17]	FUGL-MEYER A R. Post-stroke hemiplegia assessment of physical properties[J]. Scand J Rehabil Med Suppl，1980，7：85-93.
[18]	中华人民共和国卫生部. 中药新药临床研究指导原则[S]. 北京：中华人民共和国卫生部，1993：186-188.
[19]	CAVALCANTI P R, CAMPOS T F, ARAÜJO J F. Circadian and homeostatic changes of sleep-wake and quality of life in stroke：implications for neurorehabilitation[J]. Neuro Rehabilitation，2013，32(2)：337-343. DOI：10.3233/NRE-130853.
[20]	TAYLOR D J, LICHSTEIN K L, DURRENCE H H，et al. Epidemiology of insomnia，depression，and anxiety[J]. Sleep，2005，28(11)：1457-1464. DOI：10.1093/sleep/28.11.1457.
[21]	STERR A, KUHN M, NISSEN C，et al. Post-stroke insomnia in community-dwelling patients with chronic motor stroke：physiological evidence and implications for stroke care[J]. Sci Rep，2018，8(1)：8409. DOI：10.1038/s41598-018-26630-y.
[22]	吴文忠，郑诗雨，刘成勇，等. "通督调神"针刺治疗慢性失眠症及对血清GABA及CORT水平的影响[J]. 中国针灸，2021，41(7)：721-724. DOI：10.13703/j.0255-2930.20200704-k0001.
[23]	王淑兰，倪光夏. 针刺督脉经穴对局灶性脑缺血再灌注大鼠缺血半暗带MAP-2、NF-L的mRNA表达的影响[J]. 上海针灸杂志，2013，32(3)：221-223.
[24]	KARMONIK C, BRANDT A, ANDERSON J，et al. Music listening modulates functional connectivity and information flow in the human brain[J]. Brain Connect，2016，6(8)：632-641. DOI：10.1089/brain.2016.0428.
[25]	DEWAN K R, RANA P V. C-reactive protein and early mortality in acute ischemic stroke[J]. Kathmandu Univ Med J：KUMJ，2011，9(36)：252-255. DOI：10.3126/kumj.v9i4.6339.
[26]	罗本华，王燕，张亚飞，等. 三种针法对对氯苯丙氨酸诱导失眠大鼠海马5-HT1A、5-HT2A基因表达影响研究[J]. 中华中医药学刊，2017，35(10)：2630-2633. DOI：10.13193/j.issn.1673-7717.2017.10.041.
[27]	王晓秋，秦珊，吴文忠，等. 电针治疗老年失眠症及对血清褪黑素和多巴胺的影响[J]. 中国针灸，2021，41(5)：501-504. DOI：10.13703/j.0255-2930.20200404-k0001.
[28]	陈宁贵，廖敏. 解郁丸联合西酞普兰治疗难治性抑郁症的疗效及其对血清去甲肾上腺素和5-羟色胺及脑源性神经营养因子指标的影响研究[J]. 中国全科医学，2017，20(S2)：338-340.
[29]	TSAPANOU A, GU Y, MANLY J，et al. Daytime sleepiness and sleep inadequacy as risk factors for dementia[J]. Dement Geriatr Cogn Dis Extra，2015，5(2)：286-295. DOI：10.1159/000431311.
[30]	胡亮，韩雨晴. 运动抗抑郁的神经生物学机制研究新进展[J]. 陕西师范大学学报（自然科学版），2019，47(3)：9-20. DOI：10.15983/j.cnki.jsnu.2019.03.232.
[31]	SHIN Y O, LEE J B, MIN Y K，et al. Heat acclimation affects circulating levels of prostaglandin E2，COX-2 and orexin in humans[J]. Neurosci Lett，2013，542：17-20. DOI：10.1016/j.neulet.2013.03.017.

组别	例数	性别（男/女）	年龄（岁）	病程（周）	脑卒中性质（脑梗死/脑出血）
对照组	45	21/24	59.5±11.9	10.68±5.82	20/25
试验组	45	23/22	60.1±10.8	10.04±8.46	24/21
χ²（t）值		0.18	-0.25^a	0.42^a	0.71
P值		0.67	0.80	0.68	0.40

组别	例数	性别（男/女）	年龄（岁）	病程（周）	脑卒中性质（脑梗死/脑出血）
对照组	45	21/24	59.5±11.9	10.68±5.82	20/25
试验组	45	23/22	60.1±10.8	10.04±8.46	24/21
χ²（t）值		0.18	-0.25^a	0.42^a	0.71
P值		0.67	0.80	0.68	0.40

组别	例数	治愈	显效	有效	无效
对照组	45	22（48.9）	11（24.4）	7（15.6）	5（11.1）
试验组	45	23（51.1）	11（26.7）	7（17.7）	4（4.5）

组别	例数	治愈	显效	有效	无效
对照组	45	22（48.9）	11（24.4）	7（15.6）	5（11.1）
试验组	45	23（51.1）	11（26.7）	7（17.7）	4（4.5）

组别	例数	治疗前	治疗后	治疗前后评分差值	t_配对值	P值
对照组	45	12.9±2.1	6.9±1.6	5.9±2.2	41.01	<0.01
试验组	45	12.7±2.0	6.8±1.0	6.0±1.7	35.86	<0.01
t值		0.46	0.36	-0.24
P值		0.64	0.72	0.81

Efficacy and Mechanism of Action of Wuyintiaoshen Therapy in Patients with Post-stroke Insomnia

"五音调神"法治疗卒中后失眠的临床疗效及机制研究

RichHTML

PDF

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 6

References 31

Related Articles 15

Recommended Articles

Metrics

Comments

组别	例数	治疗前	治疗后	治疗前后评分差值	t_配对值	P值
对照组	45	151.0±35.9	172.2±35.9	21.2±9.6	-39.38	<0.01
试验组	45	151.0±24.3	176.1±19.3	25.2±10.8	-33.44	<0.01
t值		<0.01	-0.64	-1.86
P值		>0.05	0.52	0.07

组别	例数	治疗前	治疗后	治疗前后评分差值	t_配对值	P值
对照组	45	44.6±16.2	54.6±17.0	10.0±3.1	-24.26	<0.01
试验组	45	44.2±24.6	56.0±23.7	11.8±4.9	-17.39	<0.01
t值		0.09	-0.32	-2.22
P值		0.93	0.75	0.03

[1]	LIU Ying, LIU Shiwei, ZHANG Chi, SHEN Ji, ZHANG Yushan, ZHANG Jie, SANG Yingchen, WANG Youjiao, WANG Lei, ZHOU Houguang, SHI Hong. Prevalence and Associated Factors of Subjective Cognitive Decline among Older Stroke Patients in China [J]. Chinese General Practice, 2026, 29(20): 2829-2835.
[2]	YANG Xiaofeng, LI Xianwen, WU Yanfeng, ZHANG Qian, CHEN Juan, ZHAO Fengjiao. Association of Serum Vascular Endothelial Cadherin Levels with the Risk of Post-stroke Cognitive Impairment in Patients with Acute Ischemic Stroke [J]. Chinese General Practice, 2026, 29(20): 2867-2873.
[3]	WU Ruining, ZHOU Ming, ZHANG Gongzi, LI Jun, XIE Suhang, LIU Yangxiaoxue, ZHANG Jiali, LIU Maomao, HUANG Liping. Study on Fixed and Mobile Exoskeleton Robots in Improving Lower Limb Function and Quality of Life in Stroke Patients: a Randomized Controlled Trial [J]. Chinese General Practice, 2026, 29(17): 2326-2333.
[4]	JI Ying, GUO Chuan, ZHU Shizhe, JI Panpan, WANG Tong, KAN Chaojie, WANG Qinglei. Effects of Intermittent Theta Burst Stimulation of the Cerebellum on Different Balance Abilities in Patients with Supratentorial Stroke: a Randomized Controlled Trial [J]. Chinese General Practice, 2026, 29(15): 2022-2028.
[5]	HAN Yue, BIAN Zhe, GU Haochen, WANG Dali, PENG Yanbo. Impact of Cumulative Defined Daily Dose of Statins on Recurrence Risk in Ischemic Stroke Patients [J]. Chinese General Practice, 2026, 29(14): 1821-1826.
[6]	TIAN Anni, YANG Jing, SUN Jing, WANG Shichun. Effect of Robot-assisted Training on the Recovery of Hand Motor Function in Patients with Different Stages of Stroke: a Meta-analysis [J]. Chinese General Practice, 2026, 29(14): 1911-1920.
[7]	YU Xuefang, ZHU Min, MA Qinglin, TAN Shenlang, WU Zixing, JIANG Wei. Clinical Efficacy of Chaihu Longgu Muli Decoction Combined with Cognitive Behavioral Therapy in the Treatment of Acute Insomnia of Liver Qi Stagnation with Fire Transformation Type [J]. Chinese General Practice, 2026, 29(13): 1666-1672.
[8]	LIU Yang, LIANG Fang, WU Ling, LI Wenlei, LI Pengfei. Diagnostic Value of Non-conventional Lipids and the Triglyceride-glucose Index in First-onset Acute Ischemic Stroke [J]. Chinese General Practice, 2026, 29(11): 1422-1429.
[9]	WANG Xiaonan, RUAN Xiaonan, LIU Yang, WU Kang, QIU Hua, LIU Qingping, SONG Jiahui, GAO Jiaojiao, ZHOU Yi, LIU Xiaolin. Correlation between Anthropometric Indices and the Risk of Stroke: a Nested Case-control Study [J]. Chinese General Practice, 2026, 29(08): 1020-1028.
[10]	CAO Lei, LIU Xuechun, JIANG Wei, CHEN Yan, YAN Sunhong, DU Jing. Study on the Prediction of Muscle Attenuation in Patients with Acute Ischemic Stroke by the Cross-sectional Area and Thickness of the Temporalis Muscle [J]. Chinese General Practice, 2026, 29(08): 997-1007.
[11]	HU Naixiao, ZHANG Hao, WANG Bo, QI Xin, DONG Jianhong, XUE Ruizhong, ZHANG Qingsu. Study of the Therapeutic Effect of Intraoral Balloon Dilation Combined with K-point Stimulation in Patients with Post-stroke Pseudobulbar Palsy Associated Dysphagia and Trismus [J]. Chinese General Practice, 2026, 29(05): 591-596.
[12]	ZHAO Xuejiao, LI Juan, LI Yujie, LU Ting, Xian Lihong, YAN Huan. Prevalence Trends and Influencing Factors for Post-stroke Cognitive Impairment in China: a Meta-analysis [J]. Chinese General Practice, 2026, 29(03): 380-392.
[13]	LONG Yutong, LU Shiyu, TAN Jie, YANG Bolu, DUAN Jingying, YANG Tongde, YAN Lijing, GONG Enying, SHAO Ruitai. Long-term Medication Adherence Attitudes and Behaviors of Stroke Patients in Rural Areas of China and Related Factors: Based on Follow-up Data from a Certain County in Hebei Province [J]. Chinese General Practice, 2026, 29(02): 170-179.
[14]	FAN Zhuanzhuan, LI Wenting, MA Guoliang. Relationship between the Chinese Visceral Adipose Index and Cardiovascular Disease in Postmenopausal Women: a Prospective Cohort Study [J]. Chinese General Practice, 2026, 29(02): 180-187.
[15]	YU Hao, LIAO Peng, LUO Li. Digital Therapy for Stroke: Progress and Challenges from Screening to Intervention [J]. Chinese General Practice, 2026, 29(02): 240-246.