Acupuncture outperforms a benzodiazepine medication for the treatment of insomnia.
Researchers find acupuncture more effective for the relief of insomnia than estazolam, a benzodiazepine pharmaceutical drug. Using Pittsburgh sleep quality index (PSQI) scores as a basis of comparison, acupuncture outperformed estazolam for the improvement of “sleep quality, efficiency disturbance and daytime dysfunction.” The researchers note that the acupuncture protocol used to achieve the treatment results included a specialized order for inserting the acupuncture needles and that the “sequence of acupuncture points” plays an important role.
The investigation explored the efficacy of the Governor Vessel (GV) unblocking protocol developed by Prof. Gao Yu-chun. The researchers provide the Traditional Chinese Medicine (TCM) basis for the protocol. The GV unblocking approach to care for the treatment of insomnia focuses on calming the mind by nourishing kidney water to “submerge liver yang and harmonize heart mind by stimulating the three Yuan-Primary points Shenmen (HT7), Taichong (LR3) and Taixi (KI3).” The protocol also focuses on harmonizing the spleen and stomach. According to TCM principles, ascending “turbid qi or insufficient qi and blood due to dysfunctions of the spleen and stomach may either cause or aggravate insomnia.” To address these concerns, the following acupoints were included:
- Zhongwan (CV12)
- Tianshu (ST25)
- Yinlingquan (SP9)
The researchers note that the harmonizing functions of CV12, ST25, and SP9 combined with the Yuan acupoints help to regulate the Zang-fu organs, benefit the spleen and stomach, and improve sleeping. The GV unblocking protocol of Prof. Gao Yun-chun adds GV acupoints to the point prescription for several reasons. The researchers note that the GV connects directly with the brain, governs all yang meridians, and connects the five Zang and six Fu organs either directly or indirectly. According to TCM theory, obstruction of qi and blood flow in the GV may cause yin, yang, and Zang-Fu imbalances resulting in insomnia. Consequently, needling the GV focuses on clearing obstructions impeding the free flow of qi in the meridians, dispersing yang qi, and facilitating the distribution of nutrients.
The researchers note that the guiding treatment principle for the GV acupoint choices is to “harmonize yin and yang and improve sleep.” Baihui (GV20) is selected because it is a meeting acupoint of the Bladder Foot-Taiyang channel with the GV. GV20 functions to “tranquillize the mind.” Shenting (GV24) is chosen for its specific function to treat both insomnia and palpitations. GV24 is notable as the meeting point of the GV with the Bladder Foot-Taiyang and Stomach Yangming channels. The research indicates that the combination of GV20 with GV24 harmonizes Ying and Wei qi (nutrient and defensive qi), tranquilizes the mind, strengthens kidney qi and jing (essence), and more strongly treats insomnia. To reinforce the functions of these acupoints, Anmian (EX-HN14), Sishencong (EX-HN1), and Fengchi (GB20) are added.
The researchers cite the work of Jiang et al., noting that the “sequence of acupuncture points” is an important aspect of the treatment protocol. They add that it is a “key part” and may be a “decisive factor of the treatment effect.” Step one is to needle CV12 and ST25 to activate yang qi in the spleen, stomach, and entire body. Next, GV acupoints are needled to “unblock meridian qi and tranquilize the mind.” Step three is to needle the Yuan (source) acupoints. This assists in regulating the heart, liver, and kidneys. The researchers add that Yuan acupoints help to settle the rising liver yang and to “harmonize the heart and mind.”
The acupoint prescription had greater positive patient outcomes than estazolam for the improvement of sleep quality. In addition, the total recovery rate and marked effect rate were greater in the acupuncture group than in the estazolam group.
- The recovery rate was determined by a PSQI reductive rate ≥75% and a global PSQI score ＜11 points.
- The marked effect rate was determined by a PSQI reductive rate ≥ 50% and＜75%.
- Signs of improvement were registered at a minimal level with a PSQI reductive rate ≥ 30% and ＜50%.
The total effective rate combined the recovery, marked improvement, and minimal improvement rates. As a result, acupuncture and estazolam scored at approximately the same levels when taking into account minimal improvements. However, using only the recovery and marked effect rate, the research demonstrates that acupuncture produces significantly greater positive patient outcomes when considering significant clinical improvements.
Estazolam equaled acupuncture in one parameter. Both estazolam and acupuncture had an equal effect on sleep onset latency. This is a measure of time from wakefulness to sleep. Sleep onset latency typically measures the time it takes to go from full wakefulness to a light stage of non-REM sleep.
Patients in the estazolam group were administered 1 mg oral doses, once per day, for a total of four weeks. Patients in the acupuncture group did not receive any medications. Acupuncture points were needled with sterile, disposable 0.30 x 40 mm filiform acupuncture needles. Needles were retained for 15 – 20 minutes per acupuncture session for patients diagnosed with deficiency syndromes. For patients with a diagnosis of excess syndromes, needles were retained for 30 –40 minutes. Acupuncture was administered once per day, five times per week, for a total of four weeks.
Step one involved insertion of acupuncture needles into the following acupoints:
- Tianshu (ST25)
- Zhongwan (CV12)
- Yinlingquan (SP9)
Step two involved the following acupoints:
- Baihui (GV20)
- Shenting (GV24)
- Sishencong (EX-HN1)
- Anmian
Step three involved the following acupoints:
- Shenmen (HT7)
- Taichong (LR3)
- Taixi (KI3)
The research team provided background information to their study. Worldwide, over 35% of people in the Occident and 42% in the Orient are affected by insomnia. A combination of TCM and biomedical parameters were used for the inclusion and exclusion criteria. Patients admitted to the study had a primary complaint of insomnia combined with at least five of the following symptoms: headaches, dizziness, dream disturbed sleep, poor memory, fatigue, palpitations. These diagnostic criteria account for the TCM principle that insomnia involves both lack of sleep and consequent dysfunction.
Biomedical parameters for inclusion involves several parameters. Patients must have had a primary complaint of sleep disturbances at least three times per week for no less than one month. Patients were unable to maintain sleep, experienced poor sleep quality, or had difficulty falling asleep. The sleep issue caused excessive worrying about insomnia consequences and the sleep issue must have caused social or occupational impairment.
Exclusion criteria sorted for insomnia secondary to an illness including Parkinson’s or Alzheimer’s disease, mental illness, or systemic disorders. Patients with complications due to heart, liver, kidney, or blood disorders were also excluded from the study. In addition, patients receiving other forms of therapy were excluded. Patients were randomly divided into the medication group and the acupuncture group.
The researchers (Wang et al.) conclude that acupuncture is safe and effective for the treatment of insomnia. Further, acupuncture produces greater positive patient outcomes than estazolam intake. Based on the recovery and marked effect rate, the researchers add that acupuncture is a reliable treatment modality for patients with insomnia. As a result, the GV unblocking method is recommended by the researchers.
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References:
Wang YJ, Zhang LH, Han YX, Li PP. Efficacy observation on Governor Vessel-unblocking and mind-calming acupuncture for insomnia. Journal of Acupuncture and Tuina Science. 2016 Jul 1;14(4):274-8.
Jiang S, Di Z, Fu WB. On sequence of acupuncture points in acupuncture treatment. Zhongyi Zazhi, 2012, 53(7): 620-622.
Expert consensus panel on definition, diagnosis and drug therapy for insomnia. Expert consensus (draft) on definition, diagnosis and drug therapy for insomnia. Chin J Neurol, 2006, 39(2): 141-143.