探讨化痰解郁安神汤联合振腹推拿手法对老年慢性失眠症的临床治疗效果。【方法】将94例老年慢性失眠症痰 热内扰型患者随机分为观察组和对照组，每组各47例。对照组给予化痰解郁安神汤治疗，观察组给予化痰解郁安神汤联合 振腹推拿手法治疗，疗程为4周。观察2组患者治疗前后中医证候积分、匹兹堡睡眠质量指数（PSQI）评分、阿森斯失眠量表 （AIS）评分、疲劳量表-14（FS-14）评分、世界卫生组织生存质量测定量表简表（WHOQOL-BREF）评分以及血清褪黑素 （MT）、多巴胺（DA）、皮质醇（CORT）水平的变化情况，并评价2组患者的临床疗效。【结果】（1）疗效方面：治疗4周后，观 察组的总有效率为97.88%（46/47），对照组为87.23%（41/47），组间比较（χ2 检验），观察组的疗效明显优于对照组（P＜ 0.01）。（2）中医证候积分方面：治疗后，2组患者的主症积分和次症积分均较治疗前明显降低（P＜0.05），且观察组对主症积 分和次症积分的降低幅度均明显优于对照组（P＜0.01）。（3）相关量表评分方面：治疗后，2组患者的PSQI评分、AIS评分、 FS-14评分均较治疗前明显降低（P＜0.05），WHOQOL-BREF评分均较治疗前明显升高（P＜0.05），且观察组对PSQI评分、 AIS评分、FS-14评分的降低幅度及对WHOQOL-BREF评分的升高幅度均明显优于对照组（P＜0.01）。（4）血清学指标方面： 治疗后，2组患者的血清MT水平均较治疗前明显升高（P＜0.05），血清DA、CORT水平均较治疗前明显降低（P＜0.05），且 观察组对血清MT水平的升高幅度及对血清DA、CORT水平的降低幅度均明显优于对照组（P＜0.01）。【结论】化痰解郁安神 汤与振腹推拿手法联合治疗方案在老年慢性失眠症痰热内扰型患者中能达到较理想的应用效果，可有效调节患者的中枢神 经系统，改善患者的睡眠质量，促进机体疲劳感的消除及生活质量的提升，对提升其整体的失眠治疗效果有重要意义。

To investigate the therapeutic effect of Huatan Jieyu Anshen Decoction（mainly with the actions of resolving phlegm， relieving depression and calming mind）combined with abdominal vibration tuina manipulations on chronic insomnia in the elderly. Methods Ninety-four cases of elderly patients with chronic insomnia of phlegm-heat harassing the interior type were randomly divided into the observation group and the control group，with 47 cases in each group. The control group was given Huatan Jieyu Anshen Decoction orally， while the observation group was given oral use of Huatan Jieyu Anshen Decoction combined with abdominal vibration tuina manipulations. The course of treatment for the two groups lasted for 4 weeks. Before and after the treatment，the two groups were observed in the changes of traditional Chinese medicine（TCM）syndrome scores， Pittsburgh Sleep Quality Index（PSQI）score，Athens Insomnia Scale（AIS）score，Fatigue Scale-14（FS-14） score，World Health Organization Quality-of-Life Brief Scale（WHOQOL-BREF）score，and the serum levels of melatonin（MT），dopamine（DA），and cortisol（CORT）. After treatment，the clinical efficacy of the two groups was evaluated. Results（1）After 4 weeks of treatment，the total effective rate of the observation group was 97.88% （46/47）， while that of the control group was 87.23%（41/47）， and the intergroup comparison（tested by chisquare test）showed that the therapeutic efficacy of the observation group was superior to that of the control group （P＜0.01）.（2）After treatment， the scores of primary and secondary TCM symptoms in the two groups were significantly decreased compared with those before treatment（P＜0.05），and the decrease of the scores of primary and secondary TCM symptoms in the observation group was significantly superior to that in the control group（P＜ 0.01）.（3）After treatment，the PSQI scores，AIS scores，and FS-14 scores in the two groups were significantly decreased compared with those before treatment（P＜0.05），and the WHOQOL-BREF scores were significantly increased compared with those before treatment（P＜0.05）. The decrease of the PSQI scores，AIS scores and FS- 14 scores as well as the increase of the WHOQOL-BREF scores in the observation group was significantly superior to that in the control group（P＜0.01）. （4）After treatment，the serum MT level of both groups was significantly higher than that before treatment（P＜0.05），and the serum DA and CORT levels were significantly lower than those before treatment（P＜0.05）. The increase in serum MT level and the decrease in serum DA and CORT levels of the observation group were significantly superior to those of the control group（P＜0.01）. Conclusion The combined therapy of Huatan Jieyu Anshen Decoction combined with vibration tuina manipulations can achieve satisfactory efficacy in the elderly patients with chronic insomnia of phlegm-heat harassing the interior syndrome. The therapy is effective on regulating the central nervous system of the patients， improving the quality of the sleep，and promoting the relief of fatigue and the enhancement of the quality of life，which has great significance to the enhancement of the overall therapeutic efficacy of insomnia.

R256.23

国家自然科学基金资助项目（编号：81603417）