Magnetic Resonance Study on Restoration of the Glymphatic System and Brain Network in Insomnia Patients with TCM Physiotherapy: A Case Report

Abstract

Impairment in the cerebral glymphatic system may be one of the primary etiologic reasons for insomnia. Traditional Chinese medicine (TCM) physiotherapy is helpful for treating insomnia patients, with few side effects; however, its influence on glymphatic system function has not yet been examined. The DTI-ALPS (diffusion tensor image analysis along the perivascular space) technique and structural brain network graph theory analysis are the only current methods that can show the glymphatic system’s function and the operating efficiency of the neurofibrillary network in a noninvasive and quantitative manner, but their utility has yet to be proven. We employed DTI-ALPS and structural brain network small-worldness to examine changes in the glymphatic system’s function and the network’s working efficiency before and after TCM meridian sinew treatment in a 35-year-old female with chronic insomnia. The ALPS index and small-worldness, the Insomnia Severity Index, and the Pittsburgh Sleep Quality Index were collected at various time intervals following therapy. The results showed that the patient’s glymphatic system functioning, neurofibrillary network arrangement status, and insomnia symptoms improved during the therapy period. Additionally, her glymphatic system functioning and network status had stabilized and her quality of sleep had improved one month after the treatment ended. Thus, TCM physiotherapy can improve insomnia symptoms, and this report suggests that the corresponding mechanism of action may be achieved by repairing the glymphatic system’s function and optimizing the state of neurofibrillary network arrangement, providing a new perspective for the study of the TCM therapeutic mechanism of insomnia.

Keywords

Insomnia / Traditional Chinese medicine / Meridian sinew therapy / Glym-phatic system / Magnetic resonance imaging

Acknowledgments

None.

Funding

This study was supported by the Joint Research Fund for Enterprise and Basic and Applied Basic Research Programs of Guangdong Province of China (No. 2021A1515 220112), the Provincial Science and Technology Innovation Strategy Special Project Funding Program (No. STKJ2023042), the Guangdong Province “New Medical” Construction Steering Committee 2023 Teaching Reform Program (No. 129), and the Shantou University Medical College 2023 Teaching Quality Provincial Project.

Conflict of interest

The authors have no conflict of interests related to this publication.

Author contributions

Study design (WBZ), patient treatment (JHW), data collection (JW, YC, XHS), data analysis (BXW, XWW), manuscript writing (GBZ), manuscript revision (LMK, JHW), and manuscript fina-lization (WBZ). All authors revised the manuscript critically and approved the version to be published.

Ethical statement

This study received ethical approval from the Ethics Committee of the Second Affiliated Hospital of Shantou University Medical Col-lege (No. 2022-120) and was performed in accordance with the Dec-laration of Helsinki (as revised in 2013). Written informed consent was obtained from the patient for publication of this case report.

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