OBJECTIVE: To objectively analyze pharyngeal and cervical spine lesions in patients with insomnia. METHODS: Fifty-five patients with coexisting insomnia, pharyngeal and neck and shoulder discomfort were quantified and assigned values after observation of sleep scale, fiberoptic laryngoscopy and cervical spine frontal and lateral double oblique films for correlation analysis. The correlation coefficient between cervical lesions and insomnia was R cervical = 0.357, P=0.048; the correlation coefficient between pharyngeal lesions and insomnia was R pharynx = 0.437, P=0.007. The P-value for both was less than 0.05. Conclusion: Throat and cervical spine lesions in insomnia patients are mostly secondary and exacerbate insomnia.
Insomnia, cervical spondylosis, and pharyngitis are all clinical conditions that are closely related to many factors such as physical, mental, somatic, environmental, and pharmacological factors. The correlation between chronic pharyngitis and cervical spondylosis has been reported in the literature, and there are studies on their etiology and mutual influence mechanisms [1]. The co-existence of all three is often seen in clinical practice, but which is the cause and which is the effect has not been reported in the literature. We have observed the sleep scale, fiberoptic laryngoscopy and frontal and lateral double oblique radiographs of the cervical spine in 55 patients with insomnia as the main complaint and throat, neck and shoulder discomfort in our insomnia outpatient clinic (with a score of ≥12 or more on the internationally accepted SPIEGEL scale, meeting the diagnostic criteria of ccmd-3 insomnia), and we summarize as follows.
1.Data
Fifty-five cases with insomnia as the main complaint, along with throat discomfort (dry throat, sore throat) and neck and shoulder discomfort (neck and shoulder stagnation, hand numbness) were obtained from the insomnia specialist clinic of Yueyang Hospital of Integrative Medicine in Shanghai, from April 2006 to April 2007, including 7 cases of men and 48 cases of women, aged 35-75 years, with an average age of 50.85 years. The duration of the disease ranged from 4 weeks to 50 years.
2, Methods
2.1, Inclusion and exclusion criteria
2.1.1, Insomnia diagnosis was based on ccmd-3 criteria; cervical spine and pharyngeal lesion diagnosis was based on self-reported symptoms of pharyngeal and neck discomfort and auxiliary examination results.
2.1.2, Exclusion criteria: insomnia caused by somatic diseases or other psychiatric diseases.
2.2, Experimental methods
Fifty-five patients with insomnia as the main complaint, along with pharyngeal discomfort and neck and shoulder discomfort were asked about the sequence of onset, and observation of sleep scale, fiberoptic laryngoscopy and cervical spine frontal and lateral double oblique films were performed.
The modified SPIGEL scale was used for the sleep scale (i.e., time to fall asleep, total sleep time, number of night wakings, sleep depth, dreaming, and post-waking sensation).
Pharyngeal conditions were examined by fiberoptic laryngoscopy: including pharyngeal mucosa, tonsil size, tonsillar secretion, lymph node condition of the posterior pharyngeal wall, and mucosal condition of the posterior pharyngeal wall, all accompanied by fiberoptic laryngoscopic photographs, and quantitative values were assigned to the options of each examination item.
The frontal and double oblique X-rays of the cervical spine were observed for neck and shoulder conditions: including the physiological curvature of the cervical spine, anterior vertebral ligament, vertebral body, intervertebral disc, spinal cord cavity and intervertebral foramen, etc., and the options of each examination item were assigned quantitatively.
2.3. Assessment and analysis of the degree of the condition
Insomnia was graded according to the SPIGEL scale, and was classified as mild (<12< span="">), moderate (12-23), and severe (≥24); cervical discomfort was graded according to Nurick’s (1972) neurological classification of cervical spondylosis and MRI classification rules, and was classified as mild (≤4), moderate (5-6), and severe (≥7). The grading of pharyngeal discomfort symptoms was formulated with reference to the “Guidelines for Clinical Research on New Chinese Medicines” regarding the criteria of sore throat, itchy throat and dry throat, and was divided into light (≤4 points), moderate (5-7 points) and severe (≥8 points).
2.4. Data processing
The clinical data of all the enrolled cases that met the treatment criteria were collated, and then statistical and analysis were performed using SPSS13.0 medical statistical software to derive the proportion of each symptom, sign and examination result. The main symptoms, signs and symptoms, examination results and the degree of insomnia of pharyngeal and cervical symptoms and insomnia were analyzed, and conclusions were drawn using correlation analysis.
3. Results
3.1. Basic statistical description of the 55 observed cases
The mean score of pharyngeal symptoms was 3.76; the mean score of cervical symptoms was 3.33<4< span="">.
3.2, Stepwise regression method statistical results
For the relationship between cervical disorders and insomnia in 55 observed cases, the correlation coefficient between cervical disorders and insomnia was R cervical = 0.357, P = 0.048; the correlation coefficient between pharyngeal disorders and insomnia was R pharyngeal = 0.437, P = 0.007, and the P values of both were less than 0.05, and the correlation coefficients were statistically significant. It indicates that there is a correlation between pharyngeal and cervical disorders and insomnia, especially with cervical disorders more closely.
3.4. Analysis of the main TCM symptoms
Among the many symptoms of the 55 patients with pharyngocervical disorders combined with insomnia in this study, 51% (28/55) had difficulty falling asleep, 34.5% (19/55) woke up easily, 21.8% (12/55) woke up early, 21.8% (12/55) had excessive dreaming, 10.9 (6/55) had dizziness or headache, 10.9 (6/55) had head swelling, 9.1% (5/55) had palpitations, 9.1% (5/55) had heartburn, 9.1% (5/55) had urinary frequency 9.1% (5/55), weakness 5.5% (3/55), loss of appetite 21.8% (12/55), excessive sweating 9.1% (5/55), poor bowel movement or dry stools 29% (16/55), loose stools 10.9% (6/55), light red tongue 30.9% (17/55), red or dark red tongue 60% (33/102), yellow or yellowish greasy coating 56.4% (31/55), thin white or white greasy coating 5.5% (3/55), stringent or stringent pulse 30.9% (17/55), smooth or slippery pulse 18.2% (10/55), thin or fine pulse 50.9% (28/55), moist pulse 30.9% (17/55).
4. Discussion
Among the 55 observed cases, 67.2% were preceded by insomnia, and the majority of patients had severe insomnia (SPIEGEL scale ≥ 24 points); the mean score of pharyngeal symptoms was 3.76; the mean score of cervical spine symptoms was 3.33 <4< span=""> points. The majority of patients had severe insomnia (≥24 points on the SPIEGEL scale). The accompanying symptoms were dizziness or headache, head distension, palpitation, heartburn, frequent urination, weakness, loss of appetite, excessive sweating, poor bowel movement or dry stools, red or dark red tongue, yellow or yellowish greasy moss, thin or fine pulse, etc. Most of them were symptoms of disharmony between the Ying and Wei, rampant wind and wood, insulting gold and restraining earth, and failure to lower heart fire. If insomnia lasts for a long time, the two channels are not nourished, and the Directing Vessel is not filled up, the throat and neck will have discomfort.
Clinical epidemiological surveys show that acute and chronic pharyngitis is an important risk factor for the development of cervical spondylosis [1]. According to Chinese medicine, the pharynx and the cervical region have the same meridians, and external evil can cause both pharyngeal discomfort and “strong back”, and any of the central, liver, spleen, lung, or kidney meridians can cause discomfort in the non-diseased neck or pharynx due to their inseparable physiological and anatomical relationship. The data show that most of the pharyngeal and neck disorders in this category of patients are mild, and it can be considered that the main cause is the poor circulation of qi in the meridians and the secondary disorders, which are mainly due to the dysregulation of qi over time, the disharmony of qi and blood, the disharmony of yin and yang, the restlessness of the gods, “the restlessness of the gods is sleeplessness”, thus aggravating the symptoms of insomnia, and the loss of yin and yang in the insomniacs themselves, and once they feel external evil or produce internal evil, they cannot be dispelled as soon as possible, the lungs lose publicity and purification, and are prone to throat discomfort and The symptoms of “strong back and neck”.
In summary, the three main symptoms of this type of disease are interconnected and mutually influencing unity, mostly with insomnia first, the disease can cause the throat and neck disease over time, forming a special performance of lighter throat and neck discomfort and heavier insomnia. In clinical treatment, it is necessary to take into account all aspects of the disease, so that the individual can achieve a state of balance between yin and yang, and the disease can be healed.