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.
To explore the clinical effect and possible mechanism of action of Wuyintiaoshen therapy on post-stroke insomnia.
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.
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) .
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.
Post-stroke mild cognitive impairment (PSMCI) is a common complication after stroke, which negatively affects patients' full recovery from stroke and imposes financial and emotional pressure on their families.
To observe the clinical efficacy of moxibustion on Governor vessel on the cognitive function and TCM syndromes in PSMCI due to deficiency of kidney essence.
Eligible patients with PSMCI (n=60) who were treated in Rehabilitation Center, the First Affiliated Hospital of Henan University of CM from July 2020 to July 2021 were selected, and evenly randomized to a control group (routine basic treatment plus routine cognitive rehabilitation training) and a moxibustion group 〔routine basic treatment plus routine cognitive rehabilitation training and moxibustion on the Governor vessel acupoints (once daily, five times per week) 〕, received four consecutive weeks of treatment. The Mini-Mental State Examination (MMSE) , and Montreal Cognitive Assessment (MoCA) were used to assess the cognitive function. Symptoms of kidney essence deficiency was assessed by the Scale for the Differentiation of Syndromes of Vascular Dementia (SDSVD) . And quality of life was measured by the Specifications for Stroke-Quality of Life (SS-QOL) . The overall clinical efficacy and safety of the two treatments were evaluated.
Pre- and post-treatment comparisons of scores of MMSE and MoCA, SDSVD, and SS-QOL revealed that moxibustion group patients group had greater improvements in cognitive function, symptoms of kidney essence deficiency, and quality of life than control group patients (P<0.05) . Moreover, moxibustion group patients had better clinical outcomes (P<0.05) . The safety of treatment showed no significant intergroup differences (P>0.05) .
Moxibustion of the Governor vessel helps to better improve the cognitive function and TCM symptoms of PSMCI patients due to deficiency of kidney essence with good clinical efficacy and safety.
Depression is a common mood disorder that seriously affects the recovery of various functions in patients after stroke. Antidepressant drug therapy alone could not achieve satisfactory treatment responses.
To investigate the effects of rational emotive behavior therapy (REBT) on sleep and mood in patients with post-stroke depression.
Seventy-one patients with post-stroke depression were selected from Department of Neurological Rehabilitation, the Second Affiliated Hospital of Zhengzhou University from June 2019 to June 2020, and according to random number table, they were divided into the control group (n=35) or combined treatment group (n=36) . The control group received four consecutive weeks of treatment with oral sertraline hydrochloride tablets (25 mg per day within the first week, and 50 mg per day within other three weeks) . The combined treatment group received four consecutive weeks of treatment with REBT (three times per week, the treatment duration for each time lasting for 30 minutes) plus the same treatment for the control group. Pittsburgh Sleep Quality Index (PSQI) , Insomnia Severity Index (ISI) , 17-item Hamilton Depression Rating Scale (HAMD-17) , Hamilton Anxiety Rating Scale (HAMA) , and Modified Barthel Index (MBI) were used to assess pre- and post-treatment sleep quality, insomnia severity, depression prevalence, anxiety prevalence and ability to engage in basic activities of daily living, respectively.
The mean scores of PSQI, ISI, HAMD-17, and HAMA showed a significant decrease and the mean score of MBI demonstrated a significant increase in both groups after treatment (P<0.05) . The mean post-treatment scores for PSQI and HAMA demonstrated no significant differences between two groups (P>0.05) . The combined treatment group had lower mean post-treatment scores of ISI and HAMD-17 and higher mean post-treatment score of MBI than the control group (P<0.05) . The improvement in depression was much better in the combined treatment group (P<0.05) . The improvement in anxiety was more obviously in the combined treatment group (P<0.05) .
REBT plus oral sertraline hydrochloride tablets could produce better effects on improving insomnia, mood, and ability to engage in basic activities of daily living in patients with post-stroke depression.
