Five-Tone Therapy Plus Head and Face Massage Relieves Insomnia of Patients with Heart and Spleen Deficiency

Ming-Hui MA, Hai-Yun GAI, Ya-E NIE, Cai-Yun CUI, Zhen WANG

Department of Nursing, Xi’an Traditional Chinese Medicine Hospital, Xi’an 710021, Shaanxi, China

Abstract

Key words: Insomnia; Massage; Syndrome differentiation; Sleep quality; Integrated Chinese and western medicine

Introduction

Insomnia is a symptom manifested by the inability to enter the sleep state normally[1]. It is difficult for people to fall asleep, or to wake up easily. After waking up, they can’t go to sleep for a long time. For severe patients, it is difficult to sleep all night[2]. If patients can not alleviate the symptoms of insomnia for a long time, it will cause a series of injuries to the body and mind, such as reducing the body’s immunity, increasing the risk of developing hypertension, increasing the risk of heart and brain disease, and even causing suicidal behavior[3-6].

Causes and pathogenesis of insomnia include yin and yang disorders, zang-viscera and fu-viscera. Among them,yin and yang disorders are the fundamental factors causing the disease. At present, there are mainly drug therapy and non-drug therapies. Unsatisfactory drug treatment is mainly based on western medicine. Although the effect is fast, long-term medication can cause drug dependence and drug resistance, and withdrawal symptoms easily appears after withdrawal of drug[7-9]. Non-drug treatment mainly includes physical exercise, sleep hygiene education,medicated diet, physical therapy (magnetic therapy,sonotherapy, hyperthermia), psychotherapy (behavioral therapy, cognitive therapy, relaxation therapy). Patients are more willing to receive non-drug treatment because of their small side effects and no dependence[10,11].Therefore, exploring effective interventions for non-drugs is important for treating insomnia.

In this study, we made a study of five-tone therapy plus head and face massage versus routine treatment and nursing care in patients with insomnia caused by heart and spleen deficiency, to seek for non-drug therapy to improve sleep disorders of patients, and found that the former showed a satisfactory results, hoping to providing a reference for clinical treatment.

Materials and Methods

Diagnostic criteria

Western diagnostic criteria refer to the International Classification of Sleep Disorders, version 2 (ICSD-2,2005)[12]. The diagnostic criteria for Chinese medicine are revised according to the diagnostic criteria in the“Diagnostic and Efficacy Standards for TCM Disorders”issued by the State Administration of Traditional Chinese Medicine in 1994[13]. The main symptoms include dreaminess, easy to wake up, difficult to fall asleep,palpation and amnesia. The secondary symptoms include mental fatigue, dizziness, upset, and lustreless complexion.The tongue is pale with thin fur, and the pulse is weak and thready. The condition that all the above main symptoms accompanied with more than one secondary symptom and corresponding tongue and pulse is diagnosed as insomnia due to deficiency of heart and spleen.

Inclusion criteria

Patients aged 18 to 70 years old, with the syndrome in line with the above-mentioned diagnostic criteria for Chinese and Western medicine, the diagnostic criteria for insomnia in both Chinese and Western heart and spleen. Patients volunteered to participate and signed informed consents.

Exclusion criteria

The following patients should be excluded: patients dependent on sedative and hypnotic drugs, pregnant or lactating women, patients with the history of allergies or who cannot tolerate acupuncture and have bleeding tendency diseases, patients complicated with cardiovascular, liver, kidney and other serious diseases or mental disorders caused by secondary insomnia, patients with systemic diseases such as pain, fever, cough, surgery,etc., and those caused by external factors, and those who do not agree with clinical treatment observers.

Grouping

Sixty patients with heart and spleen deficiency type who were admitted to the Department of Encephalopathy,Xi’an Hospital of Traditional Chinese Medicine from October 2016 to August 2017 were selected as subjects and were divided into control group and experimental group according to the random number table method, 30 cases for each group. The experimental group consisted of 8 males and 22 females, aged from 20 to 67 years old, with an average of (42.5±19.2) years. The course of illness ranged from 1 to 84 months, with an average of(27.4±16.3) months. There were 9 males and 21 females in the control group, aged from 19 to 65 years, with an average of (43.5±17.5) years, and the course of disease was 4 to 80 months, with an average of (29.3±14.5)months. There was no significant difference between the two groups before intervention regarding age (t=0.211,P＞0.05), gender (χ2=0.082, P＞0.05), course of illness (t=0.477, P＞0.05).

Methods

The control group received routine treatment and nursing care. The experimental group based on the control group was given music therapy and head and face massage on the basis of the control group, once a day, 15 minutes/time, 10 times for a course of treatment, continuous observation of 2 courses. Specific steps are as follows:

Listening to musics and opening Tianmen acupoint:The patient takes the supine position, listens the musics mainly based on Zhi tone or Gong tone, such as a hundred birds toward the phoenix, bubugao, Zizhudiao (a minor of traditional music), etc., enjoys massage on Tianmen point (which is also called opening Tianmen acupoint or pushing cuanzhu acupoints), the two thumbs pushed alternately straight from bottom to top with “one finger zen”, from the middle of the two eyebrows to baihui acupoint, 3 min/time. (Figure 1a)

Pushing kangong: The thenar mass of both hands and thumbs pushed from the Yintang to the tip of the brow to the Taiyang acupoint, along a horizontal line. 3 min/time.(Figure 1b)

Pressing Taiyang acupoints: Use the butterfly flying technique to press the Taiyang acupints with the finger tips of thumbs, 2 min/time. (Figure 1c)

Kneading baihui: Pressing or kneading baihui acupoint using thumbs, 2 min/time. (Figure 1d)

Hooking Fengchi acupoint and pressing Anmian acupoint: Use the finger tip of the middle finger to hook and press fengchi acupoint to Anmian acupoint, 2 min/time. (Figure 1e)

Hooking Lianquan acupoint: Use the middle finger of both hands to hook and press from the Anmian point to Lianquan acupoint, 2min/time. (Figure 1f)

Pressing Chengjiang acupoint: Fix the lower collar with one index finger and press Chengjiang acupoint with the thumb, 1 min/time. (Figure 1g)

Efficacy assessment

The clinical efficacy was evaluated based on clinical symptoms and sleep rate improvement effects. Healing indicates symptoms disappear, sleep rate ≥75%. Significant effective indicates symptom relief, sleep rate 65% - ＜75%.Effective indicates symptoms improved, sleep rate 55% -＜65%. Invalid indicates symptoms are as before, sleep rate＜55%. Sleep rate=(actual sleep time/ total time to go to bed)×100%.

The Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality of patients before and after treatment. The sleep quality evaluation criteria used the difference between the PSQI total score and the daytime functional score to reflect the patient’s sleep quality.

Statistical analysis

Figure 1 Specific steps of head and face massage

Using SPSS19.0 software, the measurement data were expressed as mean±standard deviation (±s). Paired t-test was used for intra-group comparison, and one-way ANOVA was used between groups. Non-parametric tests are used to compare non-conforming normal distributions and variance homogeneity. The count data is expressed as a percentage (%) using the χ2test and the ranked data using the Riddit test. P＜0.05 was considered statistically significant.

Results

Comparison of clinical outcomes between the two groups

After two courses of treatment, there were 8 cases recovered, 8 cases markedly effective, 10 cases effective,4 cases invalid in the experimental group, the total effective rate was 86.67% (26/30). In the control group,5 cases were cured, 1 case markedly effective, 11 cases effective, 13 cases invalid, the total effective rate was 56.67% (17/30). The total effective rate of the experimental group was higher than that of the control group, and the difference was statistically significant (P＜0.05).

Comparison of PSQI sleep quality factors between the two groups

The results of PSQI data showed that the experimental group and the control group had lower scores than the pre-treatment scores in terms of sleep quality score, sleep time score, sleep efficiency score, sleep disturbance score,daytime dysfunction score, and Pittsburgh sleep quality score. The experimental group improved significantly regarding the time of sleep, sleep quality , sleep efficiency and overall efficacy compared with the control group, see Table 1.

Table 1 Comparison of PSQI sleep quality factors between the two groups Points

Discussion

Insomnia is a disease characterized by often difficultly in sleeping due to imbalance of yin and yang, qi-blood disharmony, and yang unable to merge into yin. The spleen and stomach transport essence of water and grain, turned into the source of yin, yang, qi, and blood, so the spleen deficiency leads to qi and blood deficiency, malnutrition of heart spirit[14]. For the treatment of insomnia, there are two major categories of drug treatment and non-medication.Western medicine-based medications have a fast onset of action, but long-term medications can develop resistance and dependence, and withdrawal symptoms can occur with sudden withdrawal[15,16]. Non-drug treatment had small adverse reactions, no dependence, and the effect is significantly more acceptable[17,18].

Chinese medicine five-tone therapy is a unique music therapy based on the traditional five-element and fivetone theories of traditional Chinese medicine, using five different musical scale of Gong, Shang, Jue, Zhi, Yu to regulate diseases[19]. As The Yellow Emperor’s Internal Classics recorded, “the functions of the five internal organs can be analogized by similar things, and the five corresponding sounds of those organs can be identified by consciousness”. Historical Records also has a detailed record, “Gong-note of the ancient Chinese five-tone corresponds to the spleen, Shang-note to the lungs, Juenote to the liver, Zhi-note to the heart, Yu-note to the kidneys.” It shows that the five tones are corresponding to the five internal organs, the five internal organs are corresponding to five emotions and five elements, and the four are blended. Hence, adjusting the five tones can adjust the function of the five internal organs and reconcile the five emotions. Modern medical research[8]has found that music has the effect of stimulating hypnosis by stimulating melatonin secretion. In this study, by playing Zhi-tone or Gong-tone musics, the patient achieves the effect of calming the mind and relaxing the body. In addition, because the traditional Chinese medicine fivetone therapy has remarkable effects and no pain, the patient is willing to accept it.

Tuina, also known as massage, is an external treatment method that the operator apply various manipulation onto the meridians and collaterals, acupuncture points or specific parts of the body to prevent and cure diseases.Chinese medicine believes that the fundamental pathogenesis of insomnia lies in “yang can’t merge into yin”, and “the head is the gathering place of various yang meridians”. Lingshu•Evil also points out, “The meeting of various yang meridians is all in the face.” Modern medicine confirmed, the manual manipulation acting on the head can make the capillaries dilated, increase the cerebral blood flow, improve the blood circulation and the nutrition of the brain[20]. The brain is the temple of the spirit, the head is the meeting of the yang, stimulation on the head points by massage can adjusts the meridian qi and blood, make yin and yang balanced, thus improving quality of sleep.

In this study, Compared with control group, the experimental group had lower scores in time of sleep,sleep quality, Sleep efficiency and overall efficacy (P all ＜0.05), indicating the experimental group improved significantly in those indicators. In conclusion, we uses head and face massage plus traditional five-tone therapy to effectively trigger the patient’s senses of touch and hearing, utilize gentle massage on acupoints of the head to make patients get benign stimulation, thus regulating qi and blood, yin and yang, and the functions of organs,tranquilizing mind and soothing nerves and improving sleep disorders of patients. Therefore, the five-tone therapy combined with head and face massage is simple to operate and effective for the treatment of insomnia with heart and spleen deficiency, so it is worth promoting.

Declaration

The authors of this article declare they have no conflict of interest.

Acknowledgements

This study was approved by the Shaanxi Provincial Administration of Traditional Chinese Medicine for funding the project (15-LC053).