Insomnia, also named ‘inability to sleep’ in traditional Chinese medicine (TCM), has an incidence of 38.2%among Chinese adult population, according to the research of Chinese Sleep Research Society in 2012[1]. It seriously affects people’s quality of life (QOL) and work.Western medicine often treats insomnia with oral administration of benzodiazepines, but these drugs may Induce dependence or even resistance when taken for a long term. Acupuncture-moxibustion can produce a significant efficacy in treating insomnia without noticeable adverse reactions[2-3]. With the development of human society, medicine has gradually transferred its focus from ‘disease’ to ‘person’. In TCM theory, there are 9 types of body constitution[4], which provides criteria for body constitution differentiation in clinic. We adopted acupuncture plus bloodletting to treat insomnia in those with a blood stasis constitution. The report is given as follows.

“美丽”是形容词，它指向一种关系，也即整合的“框架”，这种关系的指向可以用如下图表示，其中“主体”代表理解指向的主体。“美丽”在语义上理解为一个外观在视觉上被评价为高于一般水平的主体，向上的箭头表示水平的升高，“一般”表示正常水平的参照点。

1 Clinical Materials

1.1 Diagnostic criteria

1.1.1 Diagnostic criteria of Western medicine

The subjects all conformed to the diagnostic criteria for primary insomnia in Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV)[5]. The predominant complaint is difficulty initiating or maintaining sleep, for at least 1 month; the sleep disturbance causes distress or impairment in social,occupational or other areas of functioning; narcolepsy,breathing-related sleep disorder and circadian rhythm sleep disorder are excluded; the sleep disturbance is not due to major depressive disorder or generalized anxiety disorder, etc.; sleep disturbance caused by physiological problems, alcohol or drugs is excluded.

1.1.2 TCM diagnostic criteria

The TCM diagnostic criteria were based on the definition of inability to sleep in Internal Medicine of Traditional Chinese Medicine[6]: frequent inability to obtain normal sleep; majorly manifested by insufficient sleep duration or depth, with difficulty initiating sleep,nonrestorative sleep, waking multiple times or unable to go back to sleep after awakening in mild cases, or staying awake throughout the night in severe cases.1.1.3 Criteria for determining body constitution

According to the diagnostic criteria for blood stasis constitution in the self-rating scale of classification and diagnosis of body constitution of TCM[7]: bearing a potential tendency of blocked blood circulation or pathological basis of blood stagnation, and the main features including: dark complexion, pigmentation,petechia, purple lips, purple or spotted purple tongue,widened or dark-purple sublingual vessels, rough pulse;irritable and forgetful.

1.2 Inclusion criteria

Conforming to the above diagnostic criteria for primary insomnia; in accordance with the criteria for blood stasis constitution in TCM body constitution classification; age ranged between 18 and 70 years old,without limit of gender; not on any drugs or other treatments in the recent week.

1.3 Exclusion criteria

Insomnia induced by systematic disease (e.g. pain,fever) or external interruptions; pregnant or breastfeeding women; accompanied by severe primary diseases involving cardiovascular system, lungs, liver,kidney or hematopoietic system; mental disorders;those who faint during acupuncture or those allergic to the drugs used in this trial.

1.4 Statistical method

2.4.5 不同文化程度的医务人员院感知识认知正确率比较分析 比较分析不同文化程度医务人员院感知识认知正确率发现差异有统计学意义（P＜0.05），随着文化程度的提高，医务人员院感知识认知正确率逐渐增高，见表4。

1.5 General data

The 72 subjects in this study were all recruited from the Prevention Treatment Center of Zhongshan Municipal Hospital of Traditional Chinese Medicine,Guangzhou University of Chinese Medicine between January 2016 and January 2017. They were divided into a treatment group and a control group by using the random number table, 36 cases each. There were no dropouts in the two groups. In the treatment group, the age ranged from 18 to 53 years old, and the disease duration ranged from 1 month to 50 months. In the control group, the age ranged from 26 to 51 years old,and the disease duration ranged from 1 month to 72 months. There were no significant differences in the data of gender, age or disease duration between the two groups (all P＞0.05), indicating the comparability(Table 1).

2 Treatment Methods

2.1 Treatment group

Table 1. Comparison of the general data

Note: 1) x2 value; 2) t-value; 3) Z-value

Group n Gender (case) Average age(Male Female x±s, year)Average duration[M (Q1, Q3), month]Treatment 36 15 21 38.0±8.5 14.77 (2.00, 22.50)Control 36 17 19 38.2±6.1 17.39 (2.25, 23.00)Statistic value 0.2251) –0.1102) –0.5293)P-value 0.640 0.990 0.600

2.1.1 Acupuncture therapy

Acupoints: Baihui (GV 20) and bilateral Shenmen(HT 7), Sanyinjiao (SP 6), Zhaohai (KI 6), Shenmai (BL 62)and Anmian [Extra, locates at the midpoint between Yiming (EX-HN 14) and Fengchi (GB 20)].

Method: Patient took a supine position. After standard sterilization, the acupoints were punctured by filiform needles of 0.30 mm in diameter and 40 mm in length. The needles were retained for 30 min after needling qi was obtained. During the retaining, even reinforcing-reducing manipulation was applied once every 10 min.

2.1.2 Bloodletting therapy

称取5.0 g的刺葡萄皮各3份，加入0.4%盐酸溶液100 mL，于恒温40℃下水浴浸提40 min后过滤。滤渣在相同浸提条件下再进行多次浸提。确定完全浸提花青素所需次数。

Acupoint: Bilateral Geshu (BL 17) and Xinshu (BL 15).

Reduction rate of PSQI score = (Pre-treatment score -Post-treatment score) ÷ Pre-treatment score × 100%.

Method: When acupuncture was finished, patient switched to a prone position. After sterilized by iodine,each acupoint was pricked 2-3 times by a three-edged needle, followed by cupping with cups retained for 3-5 min. The amount of bleeding was supposed to be 5-10 mL for each acupoint.

After the treatment, the total effective rate was88.9%in the treatment group, higher than 83.3% in the control group. Ridit test showed U=0.37 and P=0.03,indicating a significant difference between the two groups. It’s indicated that the therapeutic efficacy of acupuncture plus bloodletting therapy should be more marked than that of oral administration of estazolam(Table 3).

2.2 Control group

Patients in the control group were intervened by oral administration of estazolam 30 min prior to sleep each night (batch number: 151102/T, Shandong Xinyi Pharmaceutical Co., Ltd., China), 1 mg per dose, once a day. The dose would be regulated to be 2 mg if the sleep quality did not show any improvement on the fourth day. The oral medication was taken once a day, 1 week as a course of treatment, for 3 successive courses in total. A follow-up study was conducted 3 months later.

3 Observation of Therapeutic Efficacy

3.1 Observation items

The scores of Pittsburgh sleep quality index (PSQI)[8]of the two groups were compared before and after the intervention, as well as in the follow-up. PSQI consists of subjective sleep quality, sleep latency, sleep duration,habitual sleep efficiency, sleep disturbances, use of sleep medication and daytime dysfunction. The global score of PSQI ranges from 0 to 21 points. The higher the score, the worse the sleep quality.

3.2 Criteria of therapeutic efficacy

The therapeutic efficacy was evaluated based on the reduction rate of PSQI score after the treatment[9].

由于元件生产厂家和批次不同，质量参差不齐，为了避免元件问题影响整个网络，在安装之前，最好对元件特别是电容进行耐压测试，符合要求后才能使用；匹配网络中的绝缘部件一定要安装牢靠，避免因接触不良而出现打火、放电等情况发生，电感与电感之间应垂直摆放，避免磁耦合效应产生。

Recovered: Reduction rate of PSQI score ≥75%.

补种水草，种植水葫芦、苦草、轮叶黑藻、凤眼莲、喜旱莲子草、水花生、水浮莲等水生植物，使虾池水草纵横成行或成簇，间隔3～5m，面积不少于全池的30%，以利小龙虾蔽荫和滋生小龙虾爱吃的浮游生物。淡水小龙虾食性杂，在动物性饲料不足的情况下也吃苦草、轮叶黑藻、凤眼莲、水浮莲、喜旱莲子草等水草植物。水草也是小龙虾隐蔽、栖息、蜕壳的理想场所，水草多的池塘环境好，养虾成活率高、产量高。

所谓“经权之辨”，便是常与变的关系。柳宗元在《断刑论》中便给出了经与权关系的最好解释：“果以为仁必知经，智必知权，是又未尽于经权之道也。何也？经也者，常也；权也者，达经者也。皆仁智之事也。离之，滋惑矣。经非权则泥，权非经则悖。”知仁首先必知经，明智必然知权。经是原则性的，适用于常态，指导一般实践；而权具有灵活性，指导的是变化的情境。将经作为基本原则进行必要的解释与适度的智慧权变相结合，这种解释活动始终遵循一个“变”字。

Markedly effective: Reduction rate of PSQI score≥50%, but ＜75%.

虽然“每日优鲜”承诺两小时送达，现在甚至90%的订单都能在1小时内送达，但对于距离前置仓较远的的订单，不少顾客反映自己下单的产品在次日都未能送达。

3.3.2 Comparison of clinical efficacy

Invalid: Reduction rate of PSQI score ＜25%.

3.3 Treatment results

3.3.1 Comparison of PSQI score

1.2 冻害发生规律 经过对历次冻害发生区域调查结果分析：从地形上看，秦岭北麓浅山区、山前河谷地带、渭河滩地以及低洼地、盆地、空气不流畅的区域冻害发生重，地势较高、平坦透风的园从来没有发生过冻害；从土壤类别看，沙土地比黏土地受冻严重；从树龄看，幼树、初果树比盛果期受冻严重；从品种看，美味猕猴桃比中华猕猴桃受冻严重，徐香猕猴桃受冻最重，海沃德、秦美、金香等也有冻害，实生苗受冻最重，红阳受冻较轻。

There was no significant difference in PSQI score between the two groups before the intervention(P＞0.05). The PSQI scores dropped significantly in both groups after the treatment (P＜0.05); there was a significant difference in the global score of PSQI between the treatment group and control group(P＜0.05), (Table 2).

Effective: Reduction rate of PSQI score ≥25%, but＜50%.

The SPSS 22 version statistical software was used for data analyses. The measurement data in normal distribution were expressed by mean ± standard deviation (x±s) and analyzed by two dependent samples t-test. The measurement data in abnormal distribution were expressed by mean (the first quartile,the third quartile) [M (Q1, Q3)], two independent sample rank-sum test for inter-group comparisons;rank-sum test for intra-group comparisons. The enumerations data were expressed by ratio and processed by Chi-square test. The comparison of therapeutic efficacy was analyzed by Ridit test. The significance level was α=0.05, and P＜0.05 indicated that the difference was statistically significant.

Treatment course: The acupuncture treatment was given once a day, 6 times a week; the bloodletting therapy was performed once a week. One-week treatment was taken as a course of treatment, and 3 successive courses were observed. A follow-up was done 3 months later.

3.3.3 Comparison of the global score of PSQI in the 3-month follow-up study

The 3-month follow-up study showed that there was a significant difference in the global score of PSQI between the two groups according to two dependent samples rank-sum test (P＜0.05), indicating that acupuncture plus bloodletting therapy can produce a more lasting efficacy in treating insomnia in a blood stasis body constitution (Table 4).

Table 2. Comparison of the global score of PSQI [M (Q1, Q3), point]

Group n Pre-treatment Post-treatment Z-value P-value Treatment 36 13.50 (12.00, 16.00) 6.50 (4.00, 7.75) –5.240 0.001 Control 36 13.50 (12.00, 15.00) 7.00 (6.00, 10.00) –5.050 0.001 Z-value –0.440 –4.030 P-value 0.600 0.001

Table 3. Comparison of clinical efficacy (case)

Group n Recovered Markedly effective Effective Invalid Total effective rate (%)Treatment 36 5 16 11 4 88.9 Control 36 3 8 19 6 83.3

Table 4. Comparison of the integrate score of PSQI in the follow-up study [M (Q1, Q3), point]

Group n Follow-up Z-value P-value Treatment 36 7.00 (6.00, 9.00) –2.350 0.018 Control 36 8.00 (7.00, 10.00)

4 Discussion

In Huang Di Nei Jing (Yellow Emperor’s Classic of Internal Medicine), insomnia is named ‘Bu De Wo’(inability to sleep), ‘Mu Bu Ming’ (inability to close the eyes), believed to be caused by pathogenic qi invading the Zang-fu organs, or the defensive qi failed to enter yin. The risk factors include improper diet, emotional disorders, fatigue, over-anxiety, chronic disease and aging, which will lead to uneasiness. When the spirit fails to guard the internal and body fails to transit from movement to stillness, insomnia will occur. The treatment of insomnia should be based on syndrome differentiation. However, the syndrome of insomnia is rather complicated, not to mention that it will vary during the treatment, making it difficult to focus on the key point[10]. Body constitution is a comparatively stable comprehensive innate feature of morphological structure, physiological function and mental state on the basis of prenatal endowment and postnatal acquisition. Body constitution runs through the whole process of disease, thus becoming an essential factor restricting and influencing the onset and development of the disease[11]. Therefore, better treatment result can be achieved with less effort paid when body constitution is well regulated.

Insomnia due to blood stasis is not rare in clinic. With extremely varied disease duration but comparatively long average duration, this type of insomnia belongs to intractable insomnia[12-13]. The onset time of blood stasis-related diseases in blood stasis constitution depends on genetic factor[14]. External traumas and internal injuries all can disturb with the production and circulation of blood, gradually forming up a blood stasis constitution. Blood stasis is usually accompanied by qi deficiency, qi stagnation and phlegm stagnation, which can block the heart vessels or impair the nutrition supply to heart and spirit, subsequently preventing yang from entering yin, and then insomnia develops when spirit fails to guard its position. In Yi Lin Gai Cuo(Correction of Errors in Medical Classics), Wang Qing-ren explained deeply the insomnia of blood stasis type, and suggested to treat it with Xue Fu Zhu Yu decoction[15].Acupuncture can produce improving effect for multiple symptoms caused by blood stasis which is featured by blood circulation disturbance and blocking of meridians[16-17]. It’s been proven by numerous clinical trials that acupuncture is safe and effective in treating insomnia[18-19], though the features of different types of insomnia and the acupuncture-moxibustion treatment for intractable insomnia still expect further study.

In this study, Baihui (GV 20) was selected for acupuncture because the Governor Vessel connects with the brain, able to regulate and calm the mind, and clear the head and eyes; the Yuan-Primary point of Heart Meridian Shenmen (HT 7) can calm the heart and tranquilize the mind; as the crossing point of Liver,Spleen and Kidney Meridians, Sanyinjiao (SP 6) can nourish blood and calm the mind; Zhaohai (KI 6)connects with the Yin Heel Vessel and Shenmai (BL 62)connects with the Yang Heel Vessel, together working to regulate and harmonize yin and yang; as an empirical point for insomnia, Anmian [Extra, locates at the midpoint between Yiming (EX-HN 14) and Fengchi(GB 20)] can tranquilize the mind and benefit sleep. The above points joining together can unblock meridians and collaterals, and regulate and harmonize yin and yang[20]. Bloodletting therapy can dredge the stagnated qi and blood in meridians and collaterals, improving the pathogenic status of blood stasis and also the biased body constitution, and finally ameliorate insomnia by targeting both causes and symptoms[21]. This study conducted a 3-month follow-up and found that the treatment group had a more stable therapeutic efficacy,indicating that this treatment protocol is worth promoting in clinic.

Conflict of Interest

长期以来，我国对天然气发电如何发展未形成共识，导致天然气发电成为近年来政策调整最为频繁的天然气利用领域。孙慧认为，一个行业的发展战略或者发展方向不宜过于频繁变动，建议要多方考量，适度松绑燃气热电联产项目，适时调整煤改气的发展方向。

The authors declared that there was no potential conflict of interest in this article.

Statement of Informed Consent

Informed consent was obtained from all individual participants or their relatives in this study.

DG-SHGR路由引用特定的数据包格式,如图4所示,其中转发模式有GSF和HBF。scaleCenter表示雷区FAR的中心位置,存储了中心位置的坐标。scaleFactor为比例因子。传输时延D表示传输数据包所限定的时延。速度门限SpeedThreshold表示满足传输时延D的最小HTHS。最后,数据Data为要传输的数据包。

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