亚健康失眠中医药干预研究
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摘要
研究背景
亚健康状态是指人的机体虽然检查无明显疾病,但呈现出疲劳,活力、反应能力和适应力减退,创造能力较弱,自我有种种不适的症状的一种生理状态。失眠是亚健康状态最为常见的证候,亚健康状态失眠是指与现代生活方式相关的原因所引起的睡眠节律(生物钟)的紊乱而致经常不易入睡,或睡后易醒,或早醒的一种状态,是大脑机能平衡失调引起的功能性疾患。中医认为人的睡眠过程是五脏六腑功能协调,气血畅达、营卫交会的结果,其中尤与心、肝、脾、肾关系密切。失眠的发生系机体内伤七情、外感六淫、饮食不节、年迈病后或者禀赋不足等多种原因,引起脏腑机能失调,营卫失和,阳不入阴所导致。
失眠在我国的发生率达29.9%。临床上失眠的治疗方法多种多样,概括起来主要有镇静催眠药物治疗、中医辨证论治、非药物治疗等。据调查,普通人群对失眠采取的对策有:服安眠药33.4%,看医师22.3%,喝中药14.5%,喝酒13.1%等等,对失眠治疗的总体满意度只有45.9%。从目前治疗失眠的现状来看,许多问题尚待解决。
失眠治疗的目标首先是建立良好的睡眠卫生习惯和正确的睡眠认知功能,教育患者学会控制与纠正各种影响睡眠的行为与认知因素,改变与消除导致失眠慢性化的持续性因素。其次是帮助患者重建较“正常”的睡眠模式,恢复正常的睡眠结构,摆脱失眠的困扰。因此,在使用药物安眠以前,失眠的治疗应该从培养睡眠卫生和纠正不良睡眠习惯开始。虽然单一的非药物治疗也能达到一定的治疗效果,但是采用心理行为治疗与药物治疗相结合的方法可以增强治疗效果,这种增强是通过药物治疗的快速效果和心理行为治疗的持续作用实现的。非药物治疗包括睡眠卫生教育、认知行为治疗、针灸治疗、推拿治疗、穴位敷贴治疗、光照治疗等。非药物治疗的首要原则是“睡眠卫生”,这对各种原因引起的失眠都是必要的,当失眠严重而睡眠卫生宣教和/或其他非药物治疗无效时,药物治疗才成为首选。
目前最常用于治疗失眠的镇静催眠药包括第2代苯二氮卓类如阿普唑仑、氯硝西泮等和第3代非苯二氮卓类如思诺思。虽然这些药物对不同的失眠都有改善作用,但由于患者无法耐受副作用和害怕药物依赖而常常求诊于中医,中药因为副作用相对较小,容易被失眠者接受。中医根据不同的病因病机和临床表现进行辨证论治,经过几千年的临床实践,积累了大量行之有效的验方。可以预计中医药将符合治疗失眠理想药物的更多特征。目前中医药对失眠治疗方案的欠缺在于虽然治疗方法种类繁多,但大都凭各自经验,不易重复验证,缺乏规范化的临床研究设计,标准化的随机双盲及远期疗效观察。
基于中医药对亚健康状态认识和干预方面的优势,以及目前尚缺乏干预亚健康失眠状态安全、有效和公认的治疗方案的现状,本课题组在前期工作的基础上,针对亚健康失眠状态人群提出我们设计的治疗方案,中医特色睡眠卫生宣教加中医药辨证论治。首先,亚健康失眠状态主要由于不良的生活方式造成睡眠节律紊乱,采用中医养生保健理念纠正不良睡眠习惯、改变歪曲的睡眠认知非常重要,这些因素既可能是失眠的诱因,也会促使失眠慢性化;其次,对亚健康失眠者进行中医药辨证论治。
研究目的
1.研究特定人群睡眠质量,筛选亚健康失眠者;研究亚健康失眠状态的中医证型分布情况,筛选亚健康失眠主要中医证型;研究亚健康失眠失眠程度特征。
2.探讨中医特色睡眠卫生宣教加中医药辨证论治对亚健康失眠的治疗作用,探索亚健康失眠治疗方案。
研究方法
1.对551名护士应用匹兹堡睡眠质量指数量表进行量表测量,对146亚健康失眠者应用亚健康失眠中医证型调查表做量表调查。
2.采用随机对照试验设计,将40例亚健康失眠者随机分配入对照组和试验组各20例,对照组采用中药辨证论治治疗,试验组采用辨证论治加中医特色睡眠卫生宣教治疗,疗程为4周,治疗前后均进行匹兹堡睡眠质量指数量表、亚健康中医证候评定量表、WHO生存质量测定量表简表和临床医生总体印象(根据访谈)CGI等的测量。
研究结果
1.护士群体睡眠质量存在问题,低睡眠质量率达45.19%;护士群体的睡眠质量问题与年龄、作息制度等因素有关。亚健康失眠状态的常见中医证型有阴虚火旺型、心脾两虚型、肝郁化火型、痰热内扰型、心胆气虚型等,其中以阴虚火旺型(41.1%)和心脾两虚型(26.7%)最为常见。146名亚健康失眠者PSQI总分均＞7分,其中以8-12分轻度失眠为主(约80.1%)。
2.通过本研究随机对照试验研究结果显示,定性分析治疗后两组的PSQI总分正常和异常例数,试验组为19例和1例,对照组为14例和6例,即试验组的睡眠质量完全改善率为95%,对照组的睡眠质量完全改善率为70%(P＞0.05),提示定性分析两组在改善睡眠质量方面没有明显差异,定量分析两组各自的治疗效果,40例亚健康失眠者治疗前后PSQI各维度分及总分比较,结果显示试验组在睡眠质量、入睡时间、睡眠时间、睡眠效率、日间功能五个维度及PSQI总分治疗前后比较差异有统计学意义(P＜0.05),对照组在睡眠质量、入睡时间、日间功能及PSQI总分治疗前后比较有统计学意义(P＜0.05),表明两组亚健康失眠者者治疗前后睡眠质量均有改善。两组亚健康失眠者治疗后匹兹堡睡眠质量指数量表各维度及总分比较,结果显示两组治疗后匹兹堡睡眠质量指数量表各维度及总分比较在入睡时间、睡眠时间、日间功能和PSQI总分差异有统计学意义(P＜0.05),提示试验组在改善入睡时间、睡眠时间、日间功能和PSQI总分方面优于对照组,表明试验组在改善睡眠治疗方面效果优于对照组。在中医症状改善方面,结果提示试验组的总有效率为100%,而对照组的总有效率达90%(P＞0.05),表明定性分析两组在改善中医症状方面比较无明显差异;两组治疗前后中医症候计分组内比较有统计学意义(P＜0.05),表明两组均能改善亚健康失眠人群中医症候。两组治疗后中医症候计分比较,结果显示,两组亚健康失眠者中医症候比较差异无统计学意义(P＞0.05),表明两组在改善中医症候效果方面没有明显差异。定量分析两组治疗前后WHO生存质量测定量表生理领域、心理领域、社会关系领域、环境领域和主观感受得分比较,结果显示两组在治疗前后WHO生存质量测定量表生理领域、心理领域、社会关系领域、环境领域和主观生存质量感受得分组内比较差异有统计学意义(P＜0.05),表明两组在生存质量各领域及主观生存质量感受均有改善。两组治疗后WHO生存质量测定量表生理领域、心理领域、社会关系领域、环境领域和主观感受得分比较,结果显示在心理领域、社会关系领域和主观生存质量感受比较差异有统计学意义(P＜0.05),表明试验组在改善WHO生存质量测定量表心理领域、社会关系领域和主观生存质量感受方面作用效果优于对照组。在临床医生总体印象方面,试验组显著进步11例,进步8例,稍进步1例,而对照组显著进步7例,进步11例,稍进步2例。比较两组亚健康失眠者治疗后CGI评分情况,结果显示两组亚健康失眠者治疗后CGI评分情况比较差异无统计学意义(P＞0.05),表明两组在改善CGI方面的效果方面比较无明显差异
研究结论
1.护士群体睡眠质量存在问题,护士群体睡眠质量远低于其他人群,应该采取相关措施改善护士的睡眠质量。护士群体的睡眠质量问题与年龄、作息制度等因素有关。亚健康失眠状态的中医证型以阴虚火旺型和心脾两虚型最为常见。亚健康失眠人群的失眠程度以轻度失眠为主。
2.中医特色睡眠卫生宣教加中医辨证治疗能够改善亚健康失眠人群的睡眠质量,中医特色睡眠卫生宣教加中医辨证治疗能够提高亚健康失眠人群生存质量。中医特色睡眠卫生宣教加中医辨证治疗干预亚健康失眠状态在改善亚健康失眠人群睡眠质量、生存质量方面较单纯中医辨证治疗效果好。
Background
Sub-health state of the body means that although the checks were no significant disease,but showed fatigue,vitality,responsiveness and adaptability to diminish the ability to create a weak,self-there are symptoms of a physiological state.Insomnia is the most common sub-health syndrome, sub-health state of insomnia is the modern way of life associated with the causes of the sleep rhythm(biological clock) is often difficult due to sleep disorders,or easy to wake up after sleeping,it' s a state of imbalance is caused by brain functional disorder.Chinese medicine practitioners believe that the process of people's sleep function is the coordination of organs, blood and accessibility,the results of Ying and Wei Fair,which particularly with the heart,liver,spleen,kidney close.Department of the occurrence of insomnia internal body Seven,Six Exogenous,diet,aging or illness,such as endowments less than a variety of reasons,causing organ dysfunction,business Wei disharmony,caused by yin-yang nothing.
The occurrence rate of insomnia in china is 29.9 percent.Clinical treatment of insomnia in a wide range,can be summed up in the treatment of sedative and hypnotic drugs,traditional Chinese medicine syndrome differentiation,non-drug treatment.According to the survey,the general population take measures to insomnia are:sleeping pills to 33.4 percent,22.3 percent see a doctor,14.5 percent of Chinese medicine to drink,alcohol 13.1% and so on,the overall treatment of insomnia,only 45.9%satisfaction.From the current status of treatment of insomnia,many issues to be resolved.
First of all,the goal of the treatment of insomnia is to establish good sleep hygiene practices and proper sleep cognitive function,education, patients learn to control and correct the effects of sleep behavior and cognitive factors that lead to change and the elimination of persistent chronic insomnia factors.The second is to help the reconstruction in patients with more "normal" sleep mode,the resumption of normal sleep architecture,from the troubled sleep.Therefore,the use of drugs in sleep before the treatment of insomnia sleep training should be to correct the adverse health and sleep habits.Although a single non-drug treatment can achieve a certain therapeutic effect,but the use of psychological-behavioral therapy with a combination of drug therapy can enhance the therapeutic effect,which is enhanced through the rapid effect of drug treatment and psychological role of behavior therapy to achieve sustained.Non-pharmacological treatments include sleep hygiene education,cognitive behavioral therapy,acupuncture therapy,massage therapy, Point Application therapy,light therapy.Non-pharmacological treatment of the primary principle is "sleep hygiene",which caused a variety of reasons for insomnia are necessary,when severe insomnia and sleep hygiene education and / or other non-drug therapy fails,drug therapy has become the first choice.
At present,the most commonly used to treat insomnia include sedative-hypnotics No.2 on behalf of benzodiazepines such as Alprazolam, Clonazepam,etc.and 3 on behalf of non-benzodiazepines such as Zolpidem. Although these drugs have been improved in a different role in insomnia,but patients can not tolerate the side effects and drug-dependent and are often afraid to seek treatment in Chinese medicine,Chinese medicine because of side effects is relatively small,easy to accept insomnia.After thousands of years of clinical practice,a large number of the accumulation wree established. Chinese medicine can be expected in line with the treatment of insomnia to be more characteristic of an ideal drug.Chinese medicine treatment of insomnia is that although the lack of a wide range of treatments,but mostly by their own experience,not easy to repeat the verification,the lack of standardization of clinical study design,standardization of the randomized, double-blind and long-term curative effect.
Chinese medicine based on the sub-health state of awareness and intervention areas,and the current lack of state intervention sub-health insomnia safe,effective and accepted treatment of the status quo,in the preparatory work of the Task Force on the basis of population for sub-health state of insomnia design our treatment programs,Chinese characteristics and increase in sleep medicine health Treatment and Education.First of all,mainly due to sub-health state of insomnia adverse lifestyle rhythm sleep disorders, the use of Chinese medicine concept of health care to correct bad sleep habits, changes the distorted perception of sleep is very important to both of these factors may be the incentive for insomnia,chronic insomnia will be prompted of;Secondly,the sleepless sub-health Treatment in Chinese medicine.
Objective:
1.Study on the quality of a specific group of people sleep,Explore the characteristics of Chinese medicine sleep
2.Health Treatment and Education of Chinese Medicine plus sub-health role in the treatment of insomnia.
Method:
1.Application for 551 nurses Scale Pittsburgh Sleep Quality Index(PSQI) for measuring scale on the 146 sub-health applications sleepless insomnia sub-health TCM Syndrome Scale questionnaire survey done.
2.A randomized controlled trial design,will be 40 cases of insomnia were randomly assigned to sub-health to the control group and 20 cases of the experimental group,control group Treatment using Chinese medicine treatment, the pilot group of sleep characteristics of syndrome differentiation of TCM increases the treatment of health education,treatment for 4 weeks,both before and after treatment for Pittsburgh Sleep Quality Index Scale,sub-health TCM Syndrome Scale,WHO Quality of Life BREF and the determination of clinicians overall impression(based on interviews) CGI and other measurements.
Result:
1.Nursing groups has problems in sleep quality,low sleep quality rate of 45.19%;nurses groups sleep quality with age,factors such as the rest of the system.Sub-health insomnia TCM common state of deficiency type Huowang type,Heart-type deficiency,stagnation of liver-type of fire,heat inside the disturbance type,heart type,such as false courage,of which deficiency Huowang type(41.1%) and Heart deficiency type(26.7%) most common.146 sleepless sub-health PSQI scores were＞7 minutes,with mild insomnia mainly 8-12 minutes(about 80.1%).
2.Through randomized controlled trials of this study results showed that a qualitative analysis of two groups after treatment PSQI scores the number of normal and abnormal cases,test group and 19 cases of group 1 cases,the control group 14 cases and 6 cases,that is,sleep quality test group fully improve the rate of 95%,the control groups to improve the quality of sleep was 70%(P＞0.05),test group tips to improve sleep quality in the group not better than the control group.Improve symptoms in traditional Chinese medicine,the results suggest that test group total effective rate was 100%, while the control group total effective rate was 90%(P＞0.05),show that the test group of Chinese medicine in improving the symptoms the same as the control group.Improvement in quality of life in the psychological field,the field of environment and subjective insomnia sub-health feelings three aspects of quality of life by comparing score before and after treatment,test group scored higher than the control group,suggesting that test group to improve the quality of life should be better than the control group.Doctors in the clinical aspects of the overall impression,test group 11 persons significant progress,progress 8,1 is slightly better,while significant progress the control group 7,progress of 11,2 is slightly better(P＜0.05).
Conclusion:
1.Nursing groups has problems in sleep quality,sleep quality groups of nurses is far lower than that of other groups,should take the relevant measures to improve the sleep quality of nurses.Sleep quality nursing groups with age, factors such as the rest of the system.Sub-health state of insomnia to TCM Syndrome and Heart deficiency Huowang the most common type.Degree of of Sub-health stste of insomnia in people is mild insomnia mainly.More women than men suffer from insomnia sub-health state of a high proportion of 30-year-old medical staff following a high proportion of sub-health state of insomnia,tertiary and postgraduate education of medical personnel is also a higher state of sub-health insomnia.
2.sleep characteristics of Chinese medicine TCM Canada Health and Education can improve the treatment of insomnia crowd sub-health sleep quality,Sleep characteristics of Chinese medicine TCM health education plus treatment can improve the quality of life in the crowd sub-health insomnia. Sleep characteristics of Chinese medicine health education intervention plus TCM treatment of insomnia sub-health state TCM treatment better than a simple effect.
亚健康状态是指人的机体虽然检查无明显疾病,但呈现出疲劳,活力、反应能力和适应力减退,创造能力较弱,自我有种种不适的症状的一种生理状态。失眠是亚健康状态最为常见的证候,亚健康状态失眠是指与现代生活方式相关的原因所引起的睡眠节律(生物钟)的紊乱而致经常不易入睡,或睡后易醒,或早醒的一种状态,是大脑机能平衡失调引起的功能性疾患。中医认为人的睡眠过程是五脏六腑功能协调,气血畅达、营卫交会的结果,其中尤与心、肝、脾、肾关系密切。失眠的发生系机体内伤七情、外感六淫、饮食不节、年迈病后或者禀赋不足等多种原因,引起脏腑机能失调,营卫失和,阳不入阴所导致。
失眠在我国的发生率达29.9%。临床上失眠的治疗方法多种多样,概括起来主要有镇静催眠药物治疗、中医辨证论治、非药物治疗等。据调查,普通人群对失眠采取的对策有:服安眠药33.4%,看医师22.3%,喝中药14.5%,喝酒13.1%等等,对失眠治疗的总体满意度只有45.9%。从目前治疗失眠的现状来看,许多问题尚待解决。
失眠治疗的目标首先是建立良好的睡眠卫生习惯和正确的睡眠认知功能,教育患者学会控制与纠正各种影响睡眠的行为与认知因素,改变与消除导致失眠慢性化的持续性因素。其次是帮助患者重建较“正常”的睡眠模式,恢复正常的睡眠结构,摆脱失眠的困扰。因此,在使用药物安眠以前,失眠的治疗应该从培养睡眠卫生和纠正不良睡眠习惯开始。虽然单一的非药物治疗也能达到一定的治疗效果,但是采用心理行为治疗与药物治疗相结合的方法可以增强治疗效果,这种增强是通过药物治疗的快速效果和心理行为治疗的持续作用实现的。非药物治疗包括睡眠卫生教育、认知行为治疗、针灸治疗、推拿治疗、穴位敷贴治疗、光照治疗等。非药物治疗的首要原则是“睡眠卫生”,这对各种原因引起的失眠都是必要的,当失眠严重而睡眠卫生宣教和/或其他非药物治疗无效时,药物治疗才成为首选。
目前最常用于治疗失眠的镇静催眠药包括第2代苯二氮卓类如阿普唑仑、氯硝西泮等和第3代非苯二氮卓类如思诺思。虽然这些药物对不同的失眠都有改善作用,但由于患者无法耐受副作用和害怕药物依赖而常常求诊于中医,中药因为副作用相对较小,容易被失眠者接受。中医根据不同的病因病机和临床表现进行辨证论治,经过几千年的临床实践,积累了大量行之有效的验方。可以预计中医药将符合治疗失眠理想药物的更多特征。目前中医药对失眠治疗方案的欠缺在于虽然治疗方法种类繁多,但大都凭各自经验,不易重复验证,缺乏规范化的临床研究设计,标准化的随机双盲及远期疗效观察。
基于中医药对亚健康状态认识和干预方面的优势,以及目前尚缺乏干预亚健康失眠状态安全、有效和公认的治疗方案的现状,本课题组在前期工作的基础上,针对亚健康失眠状态人群提出我们设计的治疗方案,中医特色睡眠卫生宣教加中医药辨证论治。首先,亚健康失眠状态主要由于不良的生活方式造成睡眠节律紊乱,采用中医养生保健理念纠正不良睡眠习惯、改变歪曲的睡眠认知非常重要,这些因素既可能是失眠的诱因,也会促使失眠慢性化;其次,对亚健康失眠者进行中医药辨证论治。
研究目的
1.研究特定人群睡眠质量,筛选亚健康失眠者;研究亚健康失眠状态的中医证型分布情况,筛选亚健康失眠主要中医证型;研究亚健康失眠失眠程度特征。
2.探讨中医特色睡眠卫生宣教加中医药辨证论治对亚健康失眠的治疗作用,探索亚健康失眠治疗方案。
研究方法
1.对551名护士应用匹兹堡睡眠质量指数量表进行量表测量,对146亚健康失眠者应用亚健康失眠中医证型调查表做量表调查。
2.采用随机对照试验设计,将40例亚健康失眠者随机分配入对照组和试验组各20例,对照组采用中药辨证论治治疗,试验组采用辨证论治加中医特色睡眠卫生宣教治疗,疗程为4周,治疗前后均进行匹兹堡睡眠质量指数量表、亚健康中医证候评定量表、WHO生存质量测定量表简表和临床医生总体印象(根据访谈)CGI等的测量。
研究结果
1.护士群体睡眠质量存在问题,低睡眠质量率达45.19%;护士群体的睡眠质量问题与年龄、作息制度等因素有关。亚健康失眠状态的常见中医证型有阴虚火旺型、心脾两虚型、肝郁化火型、痰热内扰型、心胆气虚型等,其中以阴虚火旺型(41.1%)和心脾两虚型(26.7%)最为常见。146名亚健康失眠者PSQI总分均＞7分,其中以8-12分轻度失眠为主(约80.1%)。
2.通过本研究随机对照试验研究结果显示,定性分析治疗后两组的PSQI总分正常和异常例数,试验组为19例和1例,对照组为14例和6例,即试验组的睡眠质量完全改善率为95%,对照组的睡眠质量完全改善率为70%(P＞0.05),提示定性分析两组在改善睡眠质量方面没有明显差异,定量分析两组各自的治疗效果,40例亚健康失眠者治疗前后PSQI各维度分及总分比较,结果显示试验组在睡眠质量、入睡时间、睡眠时间、睡眠效率、日间功能五个维度及PSQI总分治疗前后比较差异有统计学意义(P＜0.05),对照组在睡眠质量、入睡时间、日间功能及PSQI总分治疗前后比较有统计学意义(P＜0.05),表明两组亚健康失眠者者治疗前后睡眠质量均有改善。两组亚健康失眠者治疗后匹兹堡睡眠质量指数量表各维度及总分比较,结果显示两组治疗后匹兹堡睡眠质量指数量表各维度及总分比较在入睡时间、睡眠时间、日间功能和PSQI总分差异有统计学意义(P＜0.05),提示试验组在改善入睡时间、睡眠时间、日间功能和PSQI总分方面优于对照组,表明试验组在改善睡眠治疗方面效果优于对照组。在中医症状改善方面,结果提示试验组的总有效率为100%,而对照组的总有效率达90%(P＞0.05),表明定性分析两组在改善中医症状方面比较无明显差异;两组治疗前后中医症候计分组内比较有统计学意义(P＜0.05),表明两组均能改善亚健康失眠人群中医症候。两组治疗后中医症候计分比较,结果显示,两组亚健康失眠者中医症候比较差异无统计学意义(P＞0.05),表明两组在改善中医症候效果方面没有明显差异。定量分析两组治疗前后WHO生存质量测定量表生理领域、心理领域、社会关系领域、环境领域和主观感受得分比较,结果显示两组在治疗前后WHO生存质量测定量表生理领域、心理领域、社会关系领域、环境领域和主观生存质量感受得分组内比较差异有统计学意义(P＜0.05),表明两组在生存质量各领域及主观生存质量感受均有改善。两组治疗后WHO生存质量测定量表生理领域、心理领域、社会关系领域、环境领域和主观感受得分比较,结果显示在心理领域、社会关系领域和主观生存质量感受比较差异有统计学意义(P＜0.05),表明试验组在改善WHO生存质量测定量表心理领域、社会关系领域和主观生存质量感受方面作用效果优于对照组。在临床医生总体印象方面,试验组显著进步11例,进步8例,稍进步1例,而对照组显著进步7例,进步11例,稍进步2例。比较两组亚健康失眠者治疗后CGI评分情况,结果显示两组亚健康失眠者治疗后CGI评分情况比较差异无统计学意义(P＞0.05),表明两组在改善CGI方面的效果方面比较无明显差异
研究结论
1.护士群体睡眠质量存在问题,护士群体睡眠质量远低于其他人群,应该采取相关措施改善护士的睡眠质量。护士群体的睡眠质量问题与年龄、作息制度等因素有关。亚健康失眠状态的中医证型以阴虚火旺型和心脾两虚型最为常见。亚健康失眠人群的失眠程度以轻度失眠为主。
2.中医特色睡眠卫生宣教加中医辨证治疗能够改善亚健康失眠人群的睡眠质量,中医特色睡眠卫生宣教加中医辨证治疗能够提高亚健康失眠人群生存质量。中医特色睡眠卫生宣教加中医辨证治疗干预亚健康失眠状态在改善亚健康失眠人群睡眠质量、生存质量方面较单纯中医辨证治疗效果好。
Background
Sub-health state of the body means that although the checks were no significant disease,but showed fatigue,vitality,responsiveness and adaptability to diminish the ability to create a weak,self-there are symptoms of a physiological state.Insomnia is the most common sub-health syndrome, sub-health state of insomnia is the modern way of life associated with the causes of the sleep rhythm(biological clock) is often difficult due to sleep disorders,or easy to wake up after sleeping,it' s a state of imbalance is caused by brain functional disorder.Chinese medicine practitioners believe that the process of people's sleep function is the coordination of organs, blood and accessibility,the results of Ying and Wei Fair,which particularly with the heart,liver,spleen,kidney close.Department of the occurrence of insomnia internal body Seven,Six Exogenous,diet,aging or illness,such as endowments less than a variety of reasons,causing organ dysfunction,business Wei disharmony,caused by yin-yang nothing.
The occurrence rate of insomnia in china is 29.9 percent.Clinical treatment of insomnia in a wide range,can be summed up in the treatment of sedative and hypnotic drugs,traditional Chinese medicine syndrome differentiation,non-drug treatment.According to the survey,the general population take measures to insomnia are:sleeping pills to 33.4 percent,22.3 percent see a doctor,14.5 percent of Chinese medicine to drink,alcohol 13.1% and so on,the overall treatment of insomnia,only 45.9%satisfaction.From the current status of treatment of insomnia,many issues to be resolved.
First of all,the goal of the treatment of insomnia is to establish good sleep hygiene practices and proper sleep cognitive function,education, patients learn to control and correct the effects of sleep behavior and cognitive factors that lead to change and the elimination of persistent chronic insomnia factors.The second is to help the reconstruction in patients with more "normal" sleep mode,the resumption of normal sleep architecture,from the troubled sleep.Therefore,the use of drugs in sleep before the treatment of insomnia sleep training should be to correct the adverse health and sleep habits.Although a single non-drug treatment can achieve a certain therapeutic effect,but the use of psychological-behavioral therapy with a combination of drug therapy can enhance the therapeutic effect,which is enhanced through the rapid effect of drug treatment and psychological role of behavior therapy to achieve sustained.Non-pharmacological treatments include sleep hygiene education,cognitive behavioral therapy,acupuncture therapy,massage therapy, Point Application therapy,light therapy.Non-pharmacological treatment of the primary principle is "sleep hygiene",which caused a variety of reasons for insomnia are necessary,when severe insomnia and sleep hygiene education and / or other non-drug therapy fails,drug therapy has become the first choice.
At present,the most commonly used to treat insomnia include sedative-hypnotics No.2 on behalf of benzodiazepines such as Alprazolam, Clonazepam,etc.and 3 on behalf of non-benzodiazepines such as Zolpidem. Although these drugs have been improved in a different role in insomnia,but patients can not tolerate the side effects and drug-dependent and are often afraid to seek treatment in Chinese medicine,Chinese medicine because of side effects is relatively small,easy to accept insomnia.After thousands of years of clinical practice,a large number of the accumulation wree established. Chinese medicine can be expected in line with the treatment of insomnia to be more characteristic of an ideal drug.Chinese medicine treatment of insomnia is that although the lack of a wide range of treatments,but mostly by their own experience,not easy to repeat the verification,the lack of standardization of clinical study design,standardization of the randomized, double-blind and long-term curative effect.
Chinese medicine based on the sub-health state of awareness and intervention areas,and the current lack of state intervention sub-health insomnia safe,effective and accepted treatment of the status quo,in the preparatory work of the Task Force on the basis of population for sub-health state of insomnia design our treatment programs,Chinese characteristics and increase in sleep medicine health Treatment and Education.First of all,mainly due to sub-health state of insomnia adverse lifestyle rhythm sleep disorders, the use of Chinese medicine concept of health care to correct bad sleep habits, changes the distorted perception of sleep is very important to both of these factors may be the incentive for insomnia,chronic insomnia will be prompted of;Secondly,the sleepless sub-health Treatment in Chinese medicine.
Objective:
1.Study on the quality of a specific group of people sleep,Explore the characteristics of Chinese medicine sleep
2.Health Treatment and Education of Chinese Medicine plus sub-health role in the treatment of insomnia.
Method:
1.Application for 551 nurses Scale Pittsburgh Sleep Quality Index(PSQI) for measuring scale on the 146 sub-health applications sleepless insomnia sub-health TCM Syndrome Scale questionnaire survey done.
2.A randomized controlled trial design,will be 40 cases of insomnia were randomly assigned to sub-health to the control group and 20 cases of the experimental group,control group Treatment using Chinese medicine treatment, the pilot group of sleep characteristics of syndrome differentiation of TCM increases the treatment of health education,treatment for 4 weeks,both before and after treatment for Pittsburgh Sleep Quality Index Scale,sub-health TCM Syndrome Scale,WHO Quality of Life BREF and the determination of clinicians overall impression(based on interviews) CGI and other measurements.
Result:
1.Nursing groups has problems in sleep quality,low sleep quality rate of 45.19%;nurses groups sleep quality with age,factors such as the rest of the system.Sub-health insomnia TCM common state of deficiency type Huowang type,Heart-type deficiency,stagnation of liver-type of fire,heat inside the disturbance type,heart type,such as false courage,of which deficiency Huowang type(41.1%) and Heart deficiency type(26.7%) most common.146 sleepless sub-health PSQI scores were＞7 minutes,with mild insomnia mainly 8-12 minutes(about 80.1%).
2.Through randomized controlled trials of this study results showed that a qualitative analysis of two groups after treatment PSQI scores the number of normal and abnormal cases,test group and 19 cases of group 1 cases,the control group 14 cases and 6 cases,that is,sleep quality test group fully improve the rate of 95%,the control groups to improve the quality of sleep was 70%(P＞0.05),test group tips to improve sleep quality in the group not better than the control group.Improve symptoms in traditional Chinese medicine,the results suggest that test group total effective rate was 100%, while the control group total effective rate was 90%(P＞0.05),show that the test group of Chinese medicine in improving the symptoms the same as the control group.Improvement in quality of life in the psychological field,the field of environment and subjective insomnia sub-health feelings three aspects of quality of life by comparing score before and after treatment,test group scored higher than the control group,suggesting that test group to improve the quality of life should be better than the control group.Doctors in the clinical aspects of the overall impression,test group 11 persons significant progress,progress 8,1 is slightly better,while significant progress the control group 7,progress of 11,2 is slightly better(P＜0.05).
Conclusion:
1.Nursing groups has problems in sleep quality,sleep quality groups of nurses is far lower than that of other groups,should take the relevant measures to improve the sleep quality of nurses.Sleep quality nursing groups with age, factors such as the rest of the system.Sub-health state of insomnia to TCM Syndrome and Heart deficiency Huowang the most common type.Degree of of Sub-health stste of insomnia in people is mild insomnia mainly.More women than men suffer from insomnia sub-health state of a high proportion of 30-year-old medical staff following a high proportion of sub-health state of insomnia,tertiary and postgraduate education of medical personnel is also a higher state of sub-health insomnia.
2.sleep characteristics of Chinese medicine TCM Canada Health and Education can improve the treatment of insomnia crowd sub-health sleep quality,Sleep characteristics of Chinese medicine TCM health education plus treatment can improve the quality of life in the crowd sub-health insomnia. Sleep characteristics of Chinese medicine health education intervention plus TCM treatment of insomnia sub-health state TCM treatment better than a simple effect.
引文
[1]王育学.21世纪健康新概念[M].南昌:江西科学技术出版社,2001,12.
[2]王琦.调治亚健康状态是中医学在21世纪对人类的新贡献[J].北京中医药大学学报,2001,24(2):14.
[3]何裕民.次(亚)健康状态--中医学术拓展的新空间[J].中国中医基础杂志,1998,4(6):58.
[4]刘增垣,李美华.第三状态与心身医学研究[J].医学与哲学,2001,22(1):36-38.
[5]姚秀琴.《伤寒论》“治未病”重在脾胃[J].山东中医药大学学报,1997,21(2):101.
[6]张苏颖.金匮治未病的学术思想[J].山东中医学院学报,1990,14(2):10.
[7]尹雪萍.论《内经》治未病之预防观[J].中医函授通讯,1993,(2):1.
[8]王建.未病今释[J].中医药研究,1998,14(2):2.
[9]江乐.治未病新探[J].甘肃中医,1995,8(3):1.
[10]万晓刚.《伤寒论》未病学术思想概念[J].国医论坛,2000,15(5):1.
[11]陈立典.人体内稳系统“未病态与正气”[J].中医研究,1995,8(6):1.
[12]杨世忠,孙龙,王春妍.亚健康状态责之于肝失疏泄[J].长春中医学院学报,2003,19(1):3-4.
[13]龚海洋.王琦教授论治亚健康学术思想概要阴[J].中医药学,2003,31(4):14-16.
[14]张丽萍.亚健康状态的中医药调治思路探讨[J].陕西中医,2008,24(6):530-531.
[15]姚亚南.中医学与“亚健康”状态明[J].江西中医学院学报,2002,14(1):56.
[16]俞洁.从“阴阳失和”透视亚健康状态[J].福建中医学院学报,2003,13(4):39-40.
[17]吴丽丽,徐志伟,严灿,等.亚健康状态的中医证治探讨[J].中国临床康复,2003,7(18):2580-2581.
[18]郭振球.老年亚健康状态与中医药保健[J].河南中医学院学报,2003,18(5):11-12.
[19]岑瑞深.浅谈中医应对亚健康状态之策略[J].国医论坛,2003,18(3):44.
[20]何裕民.次(亚)健康状态--中医学术拓展的新空间[J].中国中医基础医学杂志,1998,4(6):5.
[21]何裕民.未雨绸缪,开拓生存空间--议论中医学术发展大势[J].上海中医药杂志,2000,(5):8.
[22]匡调元.中医体质病理学[M].上海:上海科学普及出版社,1996,88.
[23]栾杰男.运用中医体质理论研究亚健康状态的证型[J].中医药学报,2004,32(2):3-4
[24]姚静.试论形神学说在亚健康状态调治中的意义[J].南京中医药大学学报,2001,2(2):69-71.
[25]张丽芬.黄文政教授治疗亚健康状态的经验[J].天津中医,2004,21(2):102-104.
[26]吴童,任一心,王志国.亚健康状态的中医药防治概况[J].中医药学报,2004,32(1):57-58.
[27]李自召.中医论治亚健康状态[J].河南中医,2008,23(10):41.
[28]郭海涛.亚健康状态的辨治及用药体会[J].河南中医,2003,23(8):79-80.
[29]麻秀芳,史国富,杨槐俊,等.中华鹿龟神酒的处方分析与保健作用[J].中医药研究,1999,15(5):59.
[30]陈青山,王声勇,荆春霞,等.应用Deiphi法评价亚健康的诊断标准[J].中国公共卫生,2008,19(12):1467-1468.
[31]宋在兴.亚健康:人体潜伏的危机[M].上海:上海中医药大学出版社,2000.328.
[32]EScobar JI,HoyoS-Nervi C.Gara M.Medically:unexplained physical Symptoms in medical practice:a psychiatric perSpective.Environ Heath PerSpect 110(Suppl 4):631-636(2002).World Health Organization.Definition of Health.Available:http://www.who.int/about who/en/definition.htm[acceSSed 19 June 2002].
[33]李慧珠.勇国良.亚健康检测与防治[M].上海:上海科学技术文献出版社,2003.3-19.
[34]郭淑琴,张新江.基层医务人员实用知识更新培训教材-前沿医学[M].北京:人民军医出版社,2005.192-198.
[35]傅伟安,刘天信,王树金.某军校教员亚健康状况调查[J].中国校医,2005,19(2):142-143.
[36]Kennedy G.Abbot NC.Spence V.etal.The Specificity of the CDC-1994 criteria for chronic fatigue Syndrome:comparison of health Status in three groups of patients who fulfill the criteria.2004,14(2):95-100.
[37]王庆华,刘化侠,许红梅,等.慢性疲劳综合征诊断及预防[J].国外医学护理学分册,2005,24(7),369-372.
[38]]刘冲.预防过劳死的综合对策[J].日本医学介绍,2005,26(1),40-41.
[39]王育学.亚健康21世纪健康新概念[M].南昌:江西科学技术出版社,2002.35-46.
[40]方积乾.生命质量测定方法及运用[M].北京:北京医科大学出版社,2001.263-327.
[41]闫剑勇,丁国允,雷达.亚健康状态及其研究进展[J].中国国境卫生检疫杂志,2005,28(3):171-173.
[42]戴旭芳,连继勤.认识和预防亚健康状态[J].江苏预防医学,2005.16(1):76-78.
[43]王斌,洪永峰,吴建贤,等.慢性疲劳综合征的临床特征与研究进展[J].中国临床康复,2004,8(35):8078-8080.
[44]Whiting P.Bagnall AM,Sowden AJ,et al.InterventionS for the treatment and management of chronic fatigue Syndrome:a SyStematic review[J].JAMA.2001,286:1360-1368.
[45]蒋业政,覃月秋.我国1994-2003年亚健康研究文献的统计分析[J].中华医学图书情报,2004,(6):60-63.
[46]ReyeS M,GaryHEJr,Dobbins JG,etal.Surveillance for chronic fatigue Syndrome-four u·S.CitieS.September 1989 through AuguSt 1993[J].MMWR CDC Surveil Summ,1997,46(2):1-13.
[47]Bagnall AM,Whiting P,RichardSon R,et al.InterventionS for the treatment and management of chronic fatigue Syndrome/myalgic encephalomyelitiS[J].Qual Saf Health Care,2002,11(3):284-288.
[48]李怀美.失眠症从肝论治[J].云南中医药杂志,1997,18(2):40.
[49]戴东曦.失眠从肝论治浅析[J].浙江中医杂志,1996,3(8):367.
[50]王坤山.失眠从肝辨治八法初探[J].陕西中医,1996,17(3):116.
[51]曾庆成.辛散行气法与益气湿阳法在治疗失眠中的运用[J],湖北中医杂志,1998,20(6):27.
[52]师建梅.失眠与营卫失调[J].山西中医,1999,15(1):51.
[53]肖玉英.不寐从胃论治五法[J].安徽中医学院学报,1998,17(3):35.
[54]刘兴武.浅谈“胃不和则卧不安”[J].北京中医,1995,(4):41.
[55]苏卫东,等.不寐从脾胃论治[J].山东中医杂志,1998,17(6):247.
[56]许良,等.顽固性不寐从瘀论治[J].中医杂志,1997,38(2):82.
[57]曾伟刚.顽固性失眠从瘀论治试探[J].内蒙古中医药,1997,16(1):41.
[58]黄河清.以活血化瘀为主辨证治疗顽固性失眠43例[J].成都中医药大学学报,1996,19(4):22.
[59]赵鹏英.健脾养心法治疗失眠证[J].中国中医基础医学杂志,1997,3(增刊下):39.
[60]蔡向红,等.不寐从火论治的机理[J].中国中医基础医学杂志,1997,3(4):15.
[61]王芳,等.失眠从痰论治38例疗效观察[J].天津中医,1996,13(3):24.
[62]吴树忠,等.顽固性失眠从痰论治[J].中国中医基础医学杂志,1997,3(增刊下):43.
[63]余耀文.平肝补肾化瘀以宁神[J].上海中医药杂志,1997,(7):16.
[64]张荣英.从命门论治顽固性失眠100例[J].中医杂志,1995,36(6):333.
[65]曹智民.疏肝健脾安神汤治疗不寐48例[J].陕西中医,2002,23(2):120.
[66]王海涛,姜拥军.自拟安神汤治疗阴虚不寐30例[J].陕西中医,2002,23(2):123.
[67]林谦平,吴江.补阳还五汤加味治疗不寐60例[J].河北中医,1999,21:29.
[68]罗玉娟,袁志光.升阳益胃汤加减治疗顽固性不寐39例[J].新中医,1999,31(12):39.
[69]杨万章,张志兰,等.导龙入海汤临床应用[J].新中医,2001,33(1):13.
[70]陈群,徐志伟.安寐汤治疗失眠126例疗效观察[J].新中医,2000,32(6):18-19.
[71]钱彦方.顽固性失眠辨治体会[J].中医杂志,1998,39(11):658.
[72]蓝友明,蓝义明,鲍雪娇.知柏归脾汤治疗顽固性失眠症50例[J].福建中医,1997,28(6):51-52.
[73]李长达.中药治疗惊恐性不寐60例[J].中国民间疗法,1999,(3):40-41.
[74]陈涛,陈丰.自拟益肾养血安神汤治疗失眠症52例[J].福建中医,2000,31(1):34-35.
[75]索建兰.安眠汤治疗失眠35例报道[J].甘肃中医,2002,15(2):41.
[76]周发福.疏肝养阴汤治疗不寐证76例[J].湖南中医杂志,1998,14(3):49.
[77]王燕丽,刘茂顺.安神补心胶囊治疗不寐证疗效观察[J],北京中医.1998,(6):59-60.
[78]张洪俊.中成药治疗顽固性失眠举隅[J].中医杂志,2001,42:60.
[79]马圣华,马学清.平肝育神冲剂治疗失眠症62例临床观察[J].北京中医,1999,18(4):4-5.
[80]张红,曹晚岚,孙西庆,等.舒眠胶囊治疗失眠症151例临床观察[J].中医杂志,2008.41:418.
[81]赵青春.宁神补心片治疗失眠症300例临床观察[J].国医论坛,2001,16(2):38.
[82]李智杰,陈梁,潘德祥.清脑复神液治疗失眠症的临床与实验研究[J].湖北中医杂志,2001,23(5):9-10.
[83]姚洁心,杨艶萍.胶连安神颗粒治疗虚证失眠45例[J].四川中医,2000,18(2):33-34.
[84]温屯清.驴胶补血冲剂治疗吸毒者顽固性失眠186例[J].中医杂志,1999,40(4):202.
[85]凌玲.养脑胶囊治疗不寐52例[J].陕西中医,2002,23(2):122.
[86]王翘楚,徐建,施明,等.落花生枝枼治疗失甘民症疗效观察[J].上海中医药杂志,2001,(5):8-10.
[87]施明,许红,张晓峰,等.落花生枝枼治疗失眠症临床观察和有关药理研究[J].江苏中医药,2003,24(7):48-50.
[88]王锦槐.蝉蜕治疗失眠有奇效[J].中医杂志,1994,37(6):391.
[89]朱庚甫.平平淡淡话茯苓[J].中医杂志,1999,40(1):59.
[90]许英章.淫羊之草治疗神疲失眠,淫羊藿茶益气安神效佳[J].中华气功,2000,12:5.
[91]张学华.半夏治疗不眠症[J].中医杂志,2001,42(3):135.
[92]马明和.重用半夏治疗失眠[J].中医杂志,2001,42(2):73.
[93]付美琴,刘新生.失眠方结合辨证治疗功能性失眠120例[J].四川中医,2000,18(3):20-21.
[94]余国俊.莱菔子治便秘、不寐[J].中医杂志,1998,39(8):456.
[95]王雪英.蔓荆子泻肝潜阳治不寐[J].中医杂志,2000,41(12):713.
[96]王俊槐,王志军.重用五味子治疗失眠健忘症[J].中医杂志,1998,39(6):325.
[97]American Academy of Sleep Medicine.lhe international claSSification of Sleep diSorderS[M].DiagnoStic and coding manual.RocheSter MN:American Sleep diSorderS aSSociation,1997:112.
[98]American Academy of Sleep Medicine.The international claSSification of Sleep diSorderS[M].2nd ed.lllinoiS:American academy of Sleep medicine,2005:75.
[99]Raymond.A breakthrough in the pharmacologic management of inSomnia:overview of the clinical profile of zaleplon,primary care companion[J].Clin PSychiatey,2002,4:45.
[100]失眠定义、诊断及药物治疗共识专家组.失眠定义、诊断及药物治疗专家共识(草案)[J].中华神经科杂志,2006,39:141.
[101]Smith I,LaSSerSon TJ,Wright J.Drug therapy for obstructive Sleep apnoea in adultS[J].Cochrane DatabaSe SySt Rev,2006,19(2):CD003002.
[102]ReutenS S,Sachdev PS.Periodic limb movements and other movement diSorderS in Sleep:neuropSychiatric dimenSionS[J].Int Rev PSychiatry,2005,17(4):283.
[103]RobinSon DM,Keating GM.Sodium oxybate:a review of its use in the management of narcolepSy[J].CNS DrugS,2007,21(4):337.
[104]Mignot E,NiShino S.Emerging therapies in narcolepSycataplexy[J].Sleep,2005,28(6):754.
[105]汪瑜菡,颜红,陈立伟.自拟安神解郁汤治疗亚健康人群失眠临床观察[J].中医药临床杂志,2007,8(4):367-368.
[106]罗仁瀚,源援基,谭金庆.按摩治疗亚健康状态下的失眠症疗效观察[J].按摩与导引,2005,21(2):6.
[107]朵皓英.亚健康状态失眠的心理干预治疗[J].健康医学,2006,12(1):23.
[108]刘贤臣,唐茂芹,胡蕾,等.大学生睡眠质量与心理健康状况的相关性研究[J].中国临床心理学杂志,1995,3(1):26-28.
[109]方积乾,郝元涛.行为医学量表[J].中国行为医学科学,2001,10(特刊):19-24.
[110]王刚,张景行,徐元勇,等.一般人群睡眠质量和自测健康关系的初步研究[J].中国行为医学科学,2003,12(1):80-82.
[111]高彩虹,刘文华,王波.护理人员睡眠障碍及其相关因素的调查[J].中国医院管理.2001,21(238):33-35.
[112]傅红梅,姜华,顾立铭.精神科医护人员睡眠质量与心理健康状况的关系[J].中国行为医学科学,2005,14(4):362-363.
[113]刘连启,王汝展,刘贤臣,等.老年人睡眠质量及其相关因素研究[J].中国老年学杂志,2002,11(22):437-440.
[114]陈友兰,杨晓剑,施翠凤.厦门市城区居民睡眠质量与相关影响因素[J].中国健康教育,2004,20(12):1115-1117.
[115]金观源,相嘉嘉。现代时间学[M].长沙:湖南科学技术出版社,1993.235-248.
[116]赵英明,刘玲,周文艳.中医调治亚健康状态110例临床观察[J].天津中医,2001,18(2):20-21.
[117]马云枝.亚健康状态与中医药防治[J].河南中医,2001,21(3):11-12.
[118]余静.中医药在亚健康状态治疗中的应用[J].浙江中医学院学报,1999,23(5):6.
[119]何以蓓,寿芳,张秀峰.亚健康的中医认识及防治措施[J].浙江中医学院学报,2001,25(6):13-14.
[120]武维屏,边永君.亚健康状态的中医治疗[J].中医杂志,2000,41(4):25.
[121]袁立霞,刘刚.亚健康状态的中医药证治评析[J].中医药学刊,2005,23(3):494-495.
[122]侯冬芬,孙洁,姜睿,等.亚健康状态的中医证治规律研究[J].中医药信息,2005,22(4):1.
[123]杨豪.亚健康状态研究[J].中华实用中医学杂志,2005,13(18):247-248.
[124]宫艳华,陈宇.中医药在机体“亚健康状态”恢复过程中的作用[J].中华实用中医学杂志,2004,8(4):734.
[125]栾杰男.运用中医体质理论研究亚健康状态的证型[J].中医药学报,2004,32(2):3-4.
[126]谢雁鸣,刘保延,朴海垠,等.基于临床流行病学调查的亚健康人群一般特征的探析[J].中国中西医结合杂志,2006,26(7):612-616.
[127]于春泉,王秀莲,张炳立,等.亚健康常见证候特征的判别分析[J].辽宁中医药大学学报,2906,8(5):29-31.
[128]中医证候学诊断标准和基础资料库的重点任务与关键技术.中医现代化科技发展战略研究课题组.世界科学技术-中药现代化(药学前沿):21-25.
[129]于春泉,马寰,宫涛,等.量表学在中医证候研究中的应用探讨[J].辽宁中医杂志,2006;33(7):797-798.
[130]刘保延,何丽云,谢雁鸣,等.亚健康状态中医基本证候特征调查问卷的研制[J].中国中医基础医学杂志,2004,10(9):23-28.
[131]汪向东,王希林,马弘,等.心理卫生评定量表手册(增订版)[M].北京:中国心理卫生杂志社,1999.375-378.
[132]董玉整.亚健康及其产生的三个主要原因[J].中华流行病学杂志,2003,24(9):758-759.
[133]中华中医药学会编.亚健康中医临床指南[M].北京:中国中医药出版社,2006.1-2.
[134]中华医学会精神科分会编.中国精神障碍分类与诊断标准(第3版)[M]济南:山东科学技术出版社,2001.115-119.
[135]胡良平主编.医学统计应用错误的诊断与释疑[M],北京:军事医学科学出版社,1999.39.
[136]杨菊贤,杜勤.慢性疲劳与失眠是亚健康的重要表现[J].上海预防医学杂志,2003,15(1):45-49.
[137]黎其龙.天王补心丹加减治疗失眠症68例[J].广西中医学院院报,2007,10(2):15-16.
[138]陆俊峰.天王补心丹加减治疗甲亢引起失眠的疗效观察[J].安徽医药,2008,12(10):964-965.
[139]王玉珍,王英姿.归脾汤加刺五加注射液治疗心脾两虚型失眠35例[J].陕西中医,2008,29(5):524-525.
[140]韩莉,韩罡.归脾汤治疗失眠119例[J].基层医学论坛,2008,12(8):247-247.
[141]林本荣,俞守义,励建安,等.亚健康的诊断、分型和干预措施[J].中国康复医学杂志,2007,27(8):756-758.
[142]焦桂花,黄钢.综述失眠非药物疗法[J].现代企业文化,2008,23:76-77.
[143]李玮,周华东.失眠的研究进展[J].重庆医学,2008,37(7):730-131.
[2]王琦.调治亚健康状态是中医学在21世纪对人类的新贡献[J].北京中医药大学学报,2001,24(2):14.
[3]何裕民.次(亚)健康状态--中医学术拓展的新空间[J].中国中医基础杂志,1998,4(6):58.
[4]刘增垣,李美华.第三状态与心身医学研究[J].医学与哲学,2001,22(1):36-38.
[5]姚秀琴.《伤寒论》“治未病”重在脾胃[J].山东中医药大学学报,1997,21(2):101.
[6]张苏颖.金匮治未病的学术思想[J].山东中医学院学报,1990,14(2):10.
[7]尹雪萍.论《内经》治未病之预防观[J].中医函授通讯,1993,(2):1.
[8]王建.未病今释[J].中医药研究,1998,14(2):2.
[9]江乐.治未病新探[J].甘肃中医,1995,8(3):1.
[10]万晓刚.《伤寒论》未病学术思想概念[J].国医论坛,2000,15(5):1.
[11]陈立典.人体内稳系统“未病态与正气”[J].中医研究,1995,8(6):1.
[12]杨世忠,孙龙,王春妍.亚健康状态责之于肝失疏泄[J].长春中医学院学报,2003,19(1):3-4.
[13]龚海洋.王琦教授论治亚健康学术思想概要阴[J].中医药学,2003,31(4):14-16.
[14]张丽萍.亚健康状态的中医药调治思路探讨[J].陕西中医,2008,24(6):530-531.
[15]姚亚南.中医学与“亚健康”状态明[J].江西中医学院学报,2002,14(1):56.
[16]俞洁.从“阴阳失和”透视亚健康状态[J].福建中医学院学报,2003,13(4):39-40.
[17]吴丽丽,徐志伟,严灿,等.亚健康状态的中医证治探讨[J].中国临床康复,2003,7(18):2580-2581.
[18]郭振球.老年亚健康状态与中医药保健[J].河南中医学院学报,2003,18(5):11-12.
[19]岑瑞深.浅谈中医应对亚健康状态之策略[J].国医论坛,2003,18(3):44.
[20]何裕民.次(亚)健康状态--中医学术拓展的新空间[J].中国中医基础医学杂志,1998,4(6):5.
[21]何裕民.未雨绸缪,开拓生存空间--议论中医学术发展大势[J].上海中医药杂志,2000,(5):8.
[22]匡调元.中医体质病理学[M].上海:上海科学普及出版社,1996,88.
[23]栾杰男.运用中医体质理论研究亚健康状态的证型[J].中医药学报,2004,32(2):3-4
[24]姚静.试论形神学说在亚健康状态调治中的意义[J].南京中医药大学学报,2001,2(2):69-71.
[25]张丽芬.黄文政教授治疗亚健康状态的经验[J].天津中医,2004,21(2):102-104.
[26]吴童,任一心,王志国.亚健康状态的中医药防治概况[J].中医药学报,2004,32(1):57-58.
[27]李自召.中医论治亚健康状态[J].河南中医,2008,23(10):41.
[28]郭海涛.亚健康状态的辨治及用药体会[J].河南中医,2003,23(8):79-80.
[29]麻秀芳,史国富,杨槐俊,等.中华鹿龟神酒的处方分析与保健作用[J].中医药研究,1999,15(5):59.
[30]陈青山,王声勇,荆春霞,等.应用Deiphi法评价亚健康的诊断标准[J].中国公共卫生,2008,19(12):1467-1468.
[31]宋在兴.亚健康:人体潜伏的危机[M].上海:上海中医药大学出版社,2000.328.
[32]EScobar JI,HoyoS-Nervi C.Gara M.Medically:unexplained physical Symptoms in medical practice:a psychiatric perSpective.Environ Heath PerSpect 110(Suppl 4):631-636(2002).World Health Organization.Definition of Health.Available:http://www.who.int/about who/en/definition.htm[acceSSed 19 June 2002].
[33]李慧珠.勇国良.亚健康检测与防治[M].上海:上海科学技术文献出版社,2003.3-19.
[34]郭淑琴,张新江.基层医务人员实用知识更新培训教材-前沿医学[M].北京:人民军医出版社,2005.192-198.
[35]傅伟安,刘天信,王树金.某军校教员亚健康状况调查[J].中国校医,2005,19(2):142-143.
[36]Kennedy G.Abbot NC.Spence V.etal.The Specificity of the CDC-1994 criteria for chronic fatigue Syndrome:comparison of health Status in three groups of patients who fulfill the criteria.2004,14(2):95-100.
[37]王庆华,刘化侠,许红梅,等.慢性疲劳综合征诊断及预防[J].国外医学护理学分册,2005,24(7),369-372.
[38]]刘冲.预防过劳死的综合对策[J].日本医学介绍,2005,26(1),40-41.
[39]王育学.亚健康21世纪健康新概念[M].南昌:江西科学技术出版社,2002.35-46.
[40]方积乾.生命质量测定方法及运用[M].北京:北京医科大学出版社,2001.263-327.
[41]闫剑勇,丁国允,雷达.亚健康状态及其研究进展[J].中国国境卫生检疫杂志,2005,28(3):171-173.
[42]戴旭芳,连继勤.认识和预防亚健康状态[J].江苏预防医学,2005.16(1):76-78.
[43]王斌,洪永峰,吴建贤,等.慢性疲劳综合征的临床特征与研究进展[J].中国临床康复,2004,8(35):8078-8080.
[44]Whiting P.Bagnall AM,Sowden AJ,et al.InterventionS for the treatment and management of chronic fatigue Syndrome:a SyStematic review[J].JAMA.2001,286:1360-1368.
[45]蒋业政,覃月秋.我国1994-2003年亚健康研究文献的统计分析[J].中华医学图书情报,2004,(6):60-63.
[46]ReyeS M,GaryHEJr,Dobbins JG,etal.Surveillance for chronic fatigue Syndrome-four u·S.CitieS.September 1989 through AuguSt 1993[J].MMWR CDC Surveil Summ,1997,46(2):1-13.
[47]Bagnall AM,Whiting P,RichardSon R,et al.InterventionS for the treatment and management of chronic fatigue Syndrome/myalgic encephalomyelitiS[J].Qual Saf Health Care,2002,11(3):284-288.
[48]李怀美.失眠症从肝论治[J].云南中医药杂志,1997,18(2):40.
[49]戴东曦.失眠从肝论治浅析[J].浙江中医杂志,1996,3(8):367.
[50]王坤山.失眠从肝辨治八法初探[J].陕西中医,1996,17(3):116.
[51]曾庆成.辛散行气法与益气湿阳法在治疗失眠中的运用[J],湖北中医杂志,1998,20(6):27.
[52]师建梅.失眠与营卫失调[J].山西中医,1999,15(1):51.
[53]肖玉英.不寐从胃论治五法[J].安徽中医学院学报,1998,17(3):35.
[54]刘兴武.浅谈“胃不和则卧不安”[J].北京中医,1995,(4):41.
[55]苏卫东,等.不寐从脾胃论治[J].山东中医杂志,1998,17(6):247.
[56]许良,等.顽固性不寐从瘀论治[J].中医杂志,1997,38(2):82.
[57]曾伟刚.顽固性失眠从瘀论治试探[J].内蒙古中医药,1997,16(1):41.
[58]黄河清.以活血化瘀为主辨证治疗顽固性失眠43例[J].成都中医药大学学报,1996,19(4):22.
[59]赵鹏英.健脾养心法治疗失眠证[J].中国中医基础医学杂志,1997,3(增刊下):39.
[60]蔡向红,等.不寐从火论治的机理[J].中国中医基础医学杂志,1997,3(4):15.
[61]王芳,等.失眠从痰论治38例疗效观察[J].天津中医,1996,13(3):24.
[62]吴树忠,等.顽固性失眠从痰论治[J].中国中医基础医学杂志,1997,3(增刊下):43.
[63]余耀文.平肝补肾化瘀以宁神[J].上海中医药杂志,1997,(7):16.
[64]张荣英.从命门论治顽固性失眠100例[J].中医杂志,1995,36(6):333.
[65]曹智民.疏肝健脾安神汤治疗不寐48例[J].陕西中医,2002,23(2):120.
[66]王海涛,姜拥军.自拟安神汤治疗阴虚不寐30例[J].陕西中医,2002,23(2):123.
[67]林谦平,吴江.补阳还五汤加味治疗不寐60例[J].河北中医,1999,21:29.
[68]罗玉娟,袁志光.升阳益胃汤加减治疗顽固性不寐39例[J].新中医,1999,31(12):39.
[69]杨万章,张志兰,等.导龙入海汤临床应用[J].新中医,2001,33(1):13.
[70]陈群,徐志伟.安寐汤治疗失眠126例疗效观察[J].新中医,2000,32(6):18-19.
[71]钱彦方.顽固性失眠辨治体会[J].中医杂志,1998,39(11):658.
[72]蓝友明,蓝义明,鲍雪娇.知柏归脾汤治疗顽固性失眠症50例[J].福建中医,1997,28(6):51-52.
[73]李长达.中药治疗惊恐性不寐60例[J].中国民间疗法,1999,(3):40-41.
[74]陈涛,陈丰.自拟益肾养血安神汤治疗失眠症52例[J].福建中医,2000,31(1):34-35.
[75]索建兰.安眠汤治疗失眠35例报道[J].甘肃中医,2002,15(2):41.
[76]周发福.疏肝养阴汤治疗不寐证76例[J].湖南中医杂志,1998,14(3):49.
[77]王燕丽,刘茂顺.安神补心胶囊治疗不寐证疗效观察[J],北京中医.1998,(6):59-60.
[78]张洪俊.中成药治疗顽固性失眠举隅[J].中医杂志,2001,42:60.
[79]马圣华,马学清.平肝育神冲剂治疗失眠症62例临床观察[J].北京中医,1999,18(4):4-5.
[80]张红,曹晚岚,孙西庆,等.舒眠胶囊治疗失眠症151例临床观察[J].中医杂志,2008.41:418.
[81]赵青春.宁神补心片治疗失眠症300例临床观察[J].国医论坛,2001,16(2):38.
[82]李智杰,陈梁,潘德祥.清脑复神液治疗失眠症的临床与实验研究[J].湖北中医杂志,2001,23(5):9-10.
[83]姚洁心,杨艶萍.胶连安神颗粒治疗虚证失眠45例[J].四川中医,2000,18(2):33-34.
[84]温屯清.驴胶补血冲剂治疗吸毒者顽固性失眠186例[J].中医杂志,1999,40(4):202.
[85]凌玲.养脑胶囊治疗不寐52例[J].陕西中医,2002,23(2):122.
[86]王翘楚,徐建,施明,等.落花生枝枼治疗失甘民症疗效观察[J].上海中医药杂志,2001,(5):8-10.
[87]施明,许红,张晓峰,等.落花生枝枼治疗失眠症临床观察和有关药理研究[J].江苏中医药,2003,24(7):48-50.
[88]王锦槐.蝉蜕治疗失眠有奇效[J].中医杂志,1994,37(6):391.
[89]朱庚甫.平平淡淡话茯苓[J].中医杂志,1999,40(1):59.
[90]许英章.淫羊之草治疗神疲失眠,淫羊藿茶益气安神效佳[J].中华气功,2000,12:5.
[91]张学华.半夏治疗不眠症[J].中医杂志,2001,42(3):135.
[92]马明和.重用半夏治疗失眠[J].中医杂志,2001,42(2):73.
[93]付美琴,刘新生.失眠方结合辨证治疗功能性失眠120例[J].四川中医,2000,18(3):20-21.
[94]余国俊.莱菔子治便秘、不寐[J].中医杂志,1998,39(8):456.
[95]王雪英.蔓荆子泻肝潜阳治不寐[J].中医杂志,2000,41(12):713.
[96]王俊槐,王志军.重用五味子治疗失眠健忘症[J].中医杂志,1998,39(6):325.
[97]American Academy of Sleep Medicine.lhe international claSSification of Sleep diSorderS[M].DiagnoStic and coding manual.RocheSter MN:American Sleep diSorderS aSSociation,1997:112.
[98]American Academy of Sleep Medicine.The international claSSification of Sleep diSorderS[M].2nd ed.lllinoiS:American academy of Sleep medicine,2005:75.
[99]Raymond.A breakthrough in the pharmacologic management of inSomnia:overview of the clinical profile of zaleplon,primary care companion[J].Clin PSychiatey,2002,4:45.
[100]失眠定义、诊断及药物治疗共识专家组.失眠定义、诊断及药物治疗专家共识(草案)[J].中华神经科杂志,2006,39:141.
[101]Smith I,LaSSerSon TJ,Wright J.Drug therapy for obstructive Sleep apnoea in adultS[J].Cochrane DatabaSe SySt Rev,2006,19(2):CD003002.
[102]ReutenS S,Sachdev PS.Periodic limb movements and other movement diSorderS in Sleep:neuropSychiatric dimenSionS[J].Int Rev PSychiatry,2005,17(4):283.
[103]RobinSon DM,Keating GM.Sodium oxybate:a review of its use in the management of narcolepSy[J].CNS DrugS,2007,21(4):337.
[104]Mignot E,NiShino S.Emerging therapies in narcolepSycataplexy[J].Sleep,2005,28(6):754.
[105]汪瑜菡,颜红,陈立伟.自拟安神解郁汤治疗亚健康人群失眠临床观察[J].中医药临床杂志,2007,8(4):367-368.
[106]罗仁瀚,源援基,谭金庆.按摩治疗亚健康状态下的失眠症疗效观察[J].按摩与导引,2005,21(2):6.
[107]朵皓英.亚健康状态失眠的心理干预治疗[J].健康医学,2006,12(1):23.
[108]刘贤臣,唐茂芹,胡蕾,等.大学生睡眠质量与心理健康状况的相关性研究[J].中国临床心理学杂志,1995,3(1):26-28.
[109]方积乾,郝元涛.行为医学量表[J].中国行为医学科学,2001,10(特刊):19-24.
[110]王刚,张景行,徐元勇,等.一般人群睡眠质量和自测健康关系的初步研究[J].中国行为医学科学,2003,12(1):80-82.
[111]高彩虹,刘文华,王波.护理人员睡眠障碍及其相关因素的调查[J].中国医院管理.2001,21(238):33-35.
[112]傅红梅,姜华,顾立铭.精神科医护人员睡眠质量与心理健康状况的关系[J].中国行为医学科学,2005,14(4):362-363.
[113]刘连启,王汝展,刘贤臣,等.老年人睡眠质量及其相关因素研究[J].中国老年学杂志,2002,11(22):437-440.
[114]陈友兰,杨晓剑,施翠凤.厦门市城区居民睡眠质量与相关影响因素[J].中国健康教育,2004,20(12):1115-1117.
[115]金观源,相嘉嘉。现代时间学[M].长沙:湖南科学技术出版社,1993.235-248.
[116]赵英明,刘玲,周文艳.中医调治亚健康状态110例临床观察[J].天津中医,2001,18(2):20-21.
[117]马云枝.亚健康状态与中医药防治[J].河南中医,2001,21(3):11-12.
[118]余静.中医药在亚健康状态治疗中的应用[J].浙江中医学院学报,1999,23(5):6.
[119]何以蓓,寿芳,张秀峰.亚健康的中医认识及防治措施[J].浙江中医学院学报,2001,25(6):13-14.
[120]武维屏,边永君.亚健康状态的中医治疗[J].中医杂志,2000,41(4):25.
[121]袁立霞,刘刚.亚健康状态的中医药证治评析[J].中医药学刊,2005,23(3):494-495.
[122]侯冬芬,孙洁,姜睿,等.亚健康状态的中医证治规律研究[J].中医药信息,2005,22(4):1.
[123]杨豪.亚健康状态研究[J].中华实用中医学杂志,2005,13(18):247-248.
[124]宫艳华,陈宇.中医药在机体“亚健康状态”恢复过程中的作用[J].中华实用中医学杂志,2004,8(4):734.
[125]栾杰男.运用中医体质理论研究亚健康状态的证型[J].中医药学报,2004,32(2):3-4.
[126]谢雁鸣,刘保延,朴海垠,等.基于临床流行病学调查的亚健康人群一般特征的探析[J].中国中西医结合杂志,2006,26(7):612-616.
[127]于春泉,王秀莲,张炳立,等.亚健康常见证候特征的判别分析[J].辽宁中医药大学学报,2906,8(5):29-31.
[128]中医证候学诊断标准和基础资料库的重点任务与关键技术.中医现代化科技发展战略研究课题组.世界科学技术-中药现代化(药学前沿):21-25.
[129]于春泉,马寰,宫涛,等.量表学在中医证候研究中的应用探讨[J].辽宁中医杂志,2006;33(7):797-798.
[130]刘保延,何丽云,谢雁鸣,等.亚健康状态中医基本证候特征调查问卷的研制[J].中国中医基础医学杂志,2004,10(9):23-28.
[131]汪向东,王希林,马弘,等.心理卫生评定量表手册(增订版)[M].北京:中国心理卫生杂志社,1999.375-378.
[132]董玉整.亚健康及其产生的三个主要原因[J].中华流行病学杂志,2003,24(9):758-759.
[133]中华中医药学会编.亚健康中医临床指南[M].北京:中国中医药出版社,2006.1-2.
[134]中华医学会精神科分会编.中国精神障碍分类与诊断标准(第3版)[M]济南:山东科学技术出版社,2001.115-119.
[135]胡良平主编.医学统计应用错误的诊断与释疑[M],北京:军事医学科学出版社,1999.39.
[136]杨菊贤,杜勤.慢性疲劳与失眠是亚健康的重要表现[J].上海预防医学杂志,2003,15(1):45-49.
[137]黎其龙.天王补心丹加减治疗失眠症68例[J].广西中医学院院报,2007,10(2):15-16.
[138]陆俊峰.天王补心丹加减治疗甲亢引起失眠的疗效观察[J].安徽医药,2008,12(10):964-965.
[139]王玉珍,王英姿.归脾汤加刺五加注射液治疗心脾两虚型失眠35例[J].陕西中医,2008,29(5):524-525.
[140]韩莉,韩罡.归脾汤治疗失眠119例[J].基层医学论坛,2008,12(8):247-247.
[141]林本荣,俞守义,励建安,等.亚健康的诊断、分型和干预措施[J].中国康复医学杂志,2007,27(8):756-758.
[142]焦桂花,黄钢.综述失眠非药物疗法[J].现代企业文化,2008,23:76-77.
[143]李玮,周华东.失眠的研究进展[J].重庆医学,2008,37(7):730-131.
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