本研究目的在探討傳統中藥酸棗仁與柏子仁應用於輔助失眠患者改善睡眠品質之可行性評估。為評估酸棗仁與柏子仁對失眠患者睡眠品質改善情形，十六名（2男，14女）平均年齡50.3 ± 13.4歲經中醫師診斷為陰虛失眠的患者，進行短期四週研究。經由每日晚間8時服用濃縮製劑酸棗仁2公克、柏子仁2公克，紀錄五次服用前後的心率變異分析（HRV）數值，並以匹茲堡睡眠質量指數（PSQI）自評及中醫師診斷評估睡眠品質改善情形。結果顯示，匹茲堡睡眠質量指數由前測之13.3 ± 3.1分下降至8.4 ± 4.9分（p＜0.05）；中醫師評估項目總分由前測之12.6 ± 5.4分下降至2.2 ± 3.7分（p＜0.05），表明酸棗仁與柏子仁可一定程度的改善陰虛失眠患者之睡眠品質。另外，在心率變異分析（HRV）數值方面則無顯著性的差異，顯示短時間之內酸棗仁與柏子仁可能對心臟自律神經系統的影響並不明顯。因此酸棗仁與柏子仁可作為輔助改善睡眠品質另類療法之選擇。

　　This study is intended to assess the purpose of employing Semen Zizyphi Spinosae and Semen Biotae, two kinds of traditional Chinese medicine (TCM), to improve the sleep quality of insomniac. For the purpose of conducting this assessment, 16 patients ( 2 males and 14 females, average age of 50.3 ± 13.4 ) diagnosed by a TCM doctor as yin-xu (passive-weak) insomnia were prescribed of concentrated granules of Semen Zizyphi Spinosae and Semen Biotae,（2 grams each） to be taken orally at 8 p.m. every night for a period of four weeks. The heart rate variabilities (HRV) of patients were measured five times each, prior and posterior to taking the granules. In the meantime, the Pittsburgh Sleep Quality Index (PSQI) would be employed and assessed by the patients themselves and their sleep quality would be further assessed by the TCM doctor. As the results, indicate the PSQI felt from prior 13.3 ± 3.1 points to posterior 8.4 ± 4.9 points (p＜0.05); and the TCM doctor assessment also declined from prior 12.6 ± 5.4 points to posterior 2.2 ± 3.7 points (p＜0.05). These results clearly indicate that Semen Zizyphi Spinosae and Semen Biotae are helpful to improve the sleep quality of yin-xu insomniacs. Since no any critical variances were observed with the HRV measurement, Semen Zizyphi Spinosae and Semen Biotae did not appear to impose any significant effects on the patients'' cardio-autonomic nervous system in the prescribed duration. It is concluded that Semen Zizyphi Spinosae and Semen Biotae can be employed as a choice of complementary and alternative medicine (CAM) to improve the symptoms of insomnia.

謝誌 ………………………….……….…………….……………...……I
前言 ………...…………………………………………………………..II
摘要 ……………………………………………………………………III
英文摘要 ………………………………………………………………IV
目錄 ……………………………………………………………………VI
表次目錄 …………………………………… …….…………………...X
圖次目錄 ………………………………………………………………XI
　
第一章 緒論 ..………………………..…………………………………1
1-1 睡眠的意義與重要性 ..………….…………………………..1
1-2 睡眠障礙對人體及社會的影響 ..…………….……………..1
1-3 主流醫學對睡眠障礙的診斷與處理 ……………………….2
1-4 另類輔助療法的興起及思考 ……………………………….4
　
第二章 文獻探討 ………………………………………………………6
2-1 睡眠 ….………………………………………………………6
2-1-1 與睡眠相關之理論基礎 …………………………………..6
2-1-2 睡眠之生理結構 ………………………………...………...7
2-1-3 與睡眠相關之神經系統及神經傳遞物質 ………………..9
2-1-4 晝夜與自主神經活性的變化 …………………………..10
2-2 睡眠障礙 …….……………………………………………..16
2-2-1 睡眠品質的意義 ……………………..…………………..16
2-2-2 睡眠障礙的分類與診斷 …………………..……………..17
2-2-3 失眠的定義 …………………..…………………………..19
2-2-4 失眠的病理變化 ……………..…………………………..20
2-2-5 失眠與自主神經反應 ……………………..……………..22
2-2-6 睡眠障礙之治療方式 ……………..……………………..23
2-2-7 藥物治療模式及副作用 ………………..……………..…25
2-3 中醫學關於睡眠的基本理論 ….……………..……………27
2-3-1 概說 ………..……………………………………………..27
2-3-2 陰陽學說、節律與睡眠 ….………………………………28
2-3-3 氣、血、營衛與睡眠 …….……………………………...32
2-3-4 經絡、臟腑與睡眠 …….…………………………………34
2-3-5 中醫學對睡眠障礙的辨證 ………..……………………..36
2-3-6 酸棗仁之歷代文獻考察 …..……………………………..38
2-3-7 酸棗仁之近代文獻考察 …………..……………………..40
2-3-8 柏子仁之歷代文獻考察 ………..………………………..44
2-3-9 柏子仁之近代文獻考察 ……....…..……………………..46
2-3-10酸棗仁與柏子仁的併用及方劑舉例 ……..…………….48
　
第三章 研究動機及目的 . .51
3-1 研究動機及目的 …………………………………………51
3-2 研究假設 …………………………..……………………….52
3-3 研究架構 ……………………..…………………………….53
　
第四章 研究方法 .54
4-1 研究設計 …………………..……………………………….54
4-2 研究對象 ………..………………………………………….54
4-3 研究材料與工具 …………..……………………………….55
4-4 研究方法 …………..……………………………………….57
　
第五章 研究結果 ……………………………………………………..61
5-1 受試者基本資料 ……..…………………………………….61
5-2 受試者之睡眠品質問卷評量結果 …..…………………….63
5-4 受試者心率變異測量之結果 ……..…………………….…79
　
第六章 討論 …………………………………………………………..85
6-1 受試者之基本資料討論 ……..…………………………….85
6-2 受試者之睡眠品質問卷評量討論 ..………..……………...86
6-3 受試者陰虛睡眠障礙評估之討論 ……..……….…………91
6-4 受試者心率變異分析之討論 ………..….…………….…...94
6-5 綜合討論………….……..……….…………….……………98
　
第七章 結論與建議 ………….…………….…………….………….100
　
第八章 參考文獻 ………….…………….…………….…………….101
　
附件一 陰虛失眠患者睡眠品質評估單 ………….…………….…..113
附件二 匹茲堡睡眠品質量表（中文）………….…………….……114
附件三 受試者同意書 …..…….…………….…………….………...115
　
表次目錄
表2-1：心率變異之時域（Time Domain）分析指標……….………14
表2-2：心率變異之頻域（Frequency Domain）分析指標 .….….…15
表5-1：研究對象之年齡、身高、體重、體 脂、血壓、性別指標….62
表5-2：服用酸棗仁與柏子仁前後匹茲堡睡眠品質量表評量值 …..67
表5-3：服用酸棗仁與柏子仁前後中醫師睡眠品質評估值 ……..…75
表5-4：每週心率變異時域的測量值 ………….…………….……….80
表5-5：每週休息時坐姿在心率變異頻域的指標值 ………….……..81
　

圖次目錄
圖3-1：研究架構圖 ………….…………….…………….…………….53
圖4-1：實驗流程圖 …….…….…………….…………….……………60
圖5-1：服用酸棗仁與柏子仁前後每週匹茲堡睡眠品質量表變化 …68
圖5-2：服用酸棗仁與柏子仁前後每週匹茲堡睡眠品質量表分數 …69
圖5-3：服用酸棗仁與柏子仁前後每週匹茲堡睡眠品質量表變化 …70
圖5-4：匹茲堡睡眠品質量表評量之集群分析圖 ………….………...71
圖5-5：服用酸棗仁與柏子仁前後每週中醫師睡眠品質評估圖 ……76
圖5-6：服用酸棗仁與柏子仁前後每週中醫師睡眠品質評圖（各單項指標）………….…………….…………….………...77
圖5-7：中醫師睡眠品質評量集群分析圖 …..…….…………….…...78
圖5-8：每週心率變異時域的測量值 ………….…………….………..82
圖5-9：每週休息時坐姿在心率變異頻域的指標 ………….………...83
圖5-9：每週休息時坐姿在心率變異頻域的指標（續）………….……84

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