【目的】 基于黄元御的“中气升降，和合四维”脏腑气机升降理论，以“脏病取原，腑疾用合”为选穴原则，观察针 刺治疗慢性失眠症的临床疗效。【方法】 选取2022年3月至2023年2月阳江市中医医院治未病科收治的60例明确诊断为心胆气 虚型慢性失眠症的患者为研究对象。按随机数字表将患者随机分为观察组和对照组，每组各 30例。观察组给予针刺治疗， 对照组给予阿普唑仑片治疗，1周为1个疗程，共治疗4个疗程。治疗1个月后，评价2组临床疗效。观察2组患者治疗前后 匹兹堡睡眠质量指数（PSQI）评分的变化情况，以及汉密尔顿焦虑量表（HAMA）评分的情况。比较2组患者治疗前后汉密尔顿 抑郁量表（HAMD）评分的变化情况。【结果】（1）治疗后，2组患者的PSQI评分明显改善（P＜0.05），且观察组在改善PSQI评分 方面明显优于对照组，差异有统计学意义（P＜0.05）。（2）治疗后，2组患者的HAMA与HAMD评分明显改善（P＜0.05），且观 察组在改善HAMA与HAMD评分方面明显优于对照组，差异有统计学意义（P＜0.05）。（3）观察组总有效率为83.33%（25/30）， 对照组为70.00%（21/30）。观察组疗效优于对照组，差异有统计学意义（P＜0.05）。【结论】 基于脏腑气机升降理论应用针刺疗 法治疗慢性失眠症，能明显改善患者的抑郁与焦虑的状态，有效提高患者的睡眠质量，疗效显著。

Objective To observe the clinical efficacy of acupuncture in treating chronic insomnia disorder based on Huang Yuanyu’s theory of “central qi ascending and descending，harmony of the four dimensions” regarding visceral qi movement. Methods Sixty patients diagnosed with chronic insomnia disorder at the Preventive Treatment Department of Yangjiang Hospital of Traditional Chinese Medicine from March 2022 to February 2023. The patients were randomly divided into an observation group and a control group according to a random number table，with 30 cases in each group. The observation group received acupuncture therapy，while the control group received oral administration of Alprazolam Tablets. The treatment duration spanned 4 weeks with 1 course per week. Clinical efficacy was evaluated after 1 month，and the changes in the Pittsburgh Sleep Quality Index（PSQI） scores and Hamilton Anxiety Rating Scale（HAMA） scores were observed. The Hamilton Depression Rating Scale（HAMD） scores were compared between groups before and after treatment. Results （1） After treatment，the PSQI scores of the two groups of patients were significantly improved（P＜0.05）， and the observation group was significantly superior to the control group in improving the PSQI scores，and the difference was statistically significant（P＜ 0.05）. （2） After treatment， the HAMA scores and HAMD scores in the two groups of patients were significantly improved （P＜0.05），an the observation group in improvement of HAMA and HAMD was significantly superior to the control group， with statistically statistical significance （P＜0.05）.（3） The total effective rate was 83.33%（25/30）in the observation group and 70.00%（21/30） in the control group. The efficacy of the observation group was superior to that of the control group， and the difference was statistically significant（P＜0.05）. Conclusion Acupuncture based on the ascending and descending of visceral qi movement theory significantly alleviates anxiety and depressive states while improving sleep quality in patients with chronic insomnia disorder， demonstrating notable clinical efficacy.

R246.9

广东省中医药局科研资助项目（编号：20222273）