上下交泰针刺联合交泰汤治疗心肾不交型失眠的疗效及对神经递质的影响OA

Objective:To evaluate the clinical efficacy of Upper-Lower Jiaotai Acupuncture combined with Jiaotai Decoction(交泰汤)in treating insomnia due to heart-kidney disharmony,and to investigate its effect on serum neurotransmitter levels.Method:A total of 120 patients with insomnia due to heart-kidney disharmony were enrolled and randomly assigned into three groups by using random number table:the Decoction Group,the Acupuncture Group,and the Combination Group.The Decoction Group received oral Jiaotai Decoction;the Acupuncture Group received Upper-Lower Jiaotai Acupuncture;and the Combination Group received both treatments.The intervention lasted for 4 weeks per course,with a total of 2 courses.Outcomes were assessed at baseline,week 4,and week 8.These included the traditional Chinese medicine(TCM)syndrome score,the Insomnia Severity Index(ISI),objective sleep quality parameters[total sleep time(TST),sleep latency(SL),and wake after sleep onset(WASO)],the Self-Rating Anxiety Scale(SAS),and the Pittsburgh Sleep Quality Index(PSQI).Additionally,serum levels of neurotransmitters[gamma-aminobutyric acid(GABA),5-hydroxytryptamine(5-HT),and dopamine(DA)]were measured and compared across the three groups.Finally,the clinical efficacy and safety profiles were evaluated.Results:Compared with baseline within each group,TST,and 5-HT levels increased significantly,while TCM syndrome scores,ISI,SL,WASO,DA levels,SAS scores,and PSQI scores decreased significantly after 4 weeks and 8 weeks in all three groups(all P＜0.05).When comparing the Combination Group with the Acupuncture Group,after 8 weeks,the Combination Group exhibited significantly higher TST,GABA,and 5-HT levels,and significantly lower TCM syndrome scores,ISI,SL,WASO,DA levels,and PSQI scores(P＜0.017 for all).Compared with the Decoction Group,after 8 weeks,the Combination Group showed significantly higher TST and GABA levels,and significantly lower TCM syndrome scores,ISI,SL,WASO,DA levels,SAS scores,and PSQI scores(P＜0.017 for all).The total effective rate in the Combination Group was 90.00％,which was significantly higher than that in the Acupuncture Group(65.00％)and the Decoction Group(70.00％)(P＜0.017),while there was no significant difference in the treatment effective rate between the Acupuncture Group and the Decoction Group(P＞0.017).Conclusions:The combination of Upper-Lower Jiaotai Acupuncture and Jiaotai Decoction demonstrates high clinical efficacy in treating insomnia due to heart-kidney disharmony.This integrated therapy significantly reduces TCM syndrome scores and improves sleep quality,up-regulates serum GABA and 5-HT levels,down-regulates DA levels,rebalances neurotransmitters,alleviates anxiety,and exhibits satisfactory safety.