不同时间温针灸配合中药治疗寒湿凝滞型痛经的临床研究

发布时间：2018-05-24 17:39

本文选题：不同时间 + 温针灸　；参考：《广州中医药大学》2017年博士论文

【摘要】：目的(1)本研究采用临床随机对照试验观察不同时间介入温针灸配合中药治疗寒湿凝滞型痛经的临床效果,探究温针灸配合中药治疗寒湿凝滞型痛经的最佳介入时间。(2)比较不同时间温针灸配合中药及单纯中药治疗寒湿凝滞型痛经的疗效差异,为临床优化痛经的治疗方案提供依据。方法受试者来源于香港中医综合中心的病人,将符合本研究纳入标准的130例观察对象,采用随机分组,按1:1:1:1比例分为四组:经前5天温针灸+中药组(A组)32例、经前3天温针灸+中药组(B组)32例、经行第1天温针灸+中药组(C组)33例和中药空白对照组(D组)33例。A组:温针灸从月经来潮前5天开始,每日治疗1次,连续治疗5天,连续治疗3个月经周期。针刺用具采用一次性不锈钢无菌针,规格为0.25*40mm。针刺处方选用中极、关元、三阴交(双)、地机(双)、水道(双)、归来(双),采用"岭南陈氏针法"快速旋转进针,地机、水道、归来采用大泻法,其余穴位采用平补平泻手法使其得气,然后将一段长约2cm的艾段点燃插在每支针柄上,并准备2*3cm大的硬纸片一张,剪开一端套在针体上,阻隔艾段避免烧伤腧穴处的皮肤,以治疗过程中温针灸的穴位有温热感为度。当艾段燃尽后拔针除去灰烬,整个治疗时间为20分钟。中药服法:服用中药颗粒冲剂,方为少腹逐瘀汤加苍术、茯苓,在月经前5天服用,至月经来潮第5天停服,每日服用1次,共服10天,连续服用3个月。冲服法是将中药颗粒放在容器内,用合适温度的开水约200毫升冲服。B组:温针灸从月经来潮前3天开始,每日治疗1次,连续治疗5天,连续治疗3个月经周期。针刺处方及操作与A组温针组相同,中药处方及冲服方法与A组中药组相同。C组:温针灸从月经来潮第1天开始,每日治疗1次,连续治疗5天,连续治疗3个月经周期。针刺处方及操作与A组温针组相同,中药处方及冲服方法与A组中药组相同。D组:中药处方及冲服方法与A组中药组相同。四组研究试验者均要求在治疗前、治疗1,2,3个月、第6个月(随访月)填写NRS疼痛评分量表及CMSS痛经症状量表,对试验者的经行腹痛及经行伴随症状在程度及频率分数进行评估,每次由专责人员收集量表,客观地评估各组疗效。所有资料均采用SPSS24.0统计软件进行统计分析。结果治疗过程中A组脱落2例,B组脱落2例,C组脱落3例,D组脱落3例,实际完成临床观察病例120个,其中A组30例,B组30例,C组30例,D组30例。(1)治疗前分别对四组年龄、病程、治疗前NRS疼痛评分量表评分、CMSS痛经症状发作频率总分及程度总分进行基线分析,各组间比较差别无统计学意义(P0.05),具有可比性。(2)四组治疗前与治疗3个月的NRS疼痛评分量表评分经过重复测量的方差分析,A组检验结果P=0.01(0.05),B组检验结果P=0.01(0.05),C 组检验结果 P=0.03(0.05),D 组检验结果 P=0.04(0.05),说明四组治疗3个月有明显的止痛效果,其中A组,B组的止痛效果优于C组,D组,说明经前5天及3天介入温针灸配合中药的疗效优于经行第1天介入温针灸配合中药治疗及单纯中药治疗。(3)四组NRS疼痛评分量表评分总有效率A组总有效率为96.67%;B组总有效率为93.33%。C组总有效率为90.00%;D组总有效率为76.67%。四组病例治疗后的NRS疗效比较有极显着性差异(P0.01)。(4)四组在治疗1,2,3个月的CMSS痛经症状频率总分比较A组与B组的差异没有统计学意义(P0.05);A组与C组、A组与D组、B组与C组、B组与D组、C组与D组在3个月都有明显的差异(P0.05),提示温针灸配合中药治疗比单纯用中药治疗优胜,而且经前5天及3天介入温针灸的疗效优于经行第1天介入温针灸。(5)四组在治疗第1,2,3个月的CMSS痛经症状程度总分比较A组与B组的差异没有统计学意义(P0.05);A组与C组、A组与D组、B组与C组、B组与D组、C组与D组在3个月都有明显的差异(P0.05),提示温针灸配合中药治疗比单纯用中药治疗优胜,而且经前5天及3天介入温针灸的疗效优于经行第1天介入温针灸。(6)四组在第6个月随访的CMSS痛经症状频率总分比较A组与B组、A组与C组、A组与D组、B组与C组、B组与D组、C组与D组在3个月都有明显的差异(P0.05),提示温针灸配合中药治疗比单纯用中药治疗优胜,而且经前5天介入温针灸的持续疗效优于经前3天介入的持续疗效,经前3天介入温针灸的疗效优于经行第1天介入温针灸的疗效,提示越早介入温针灸治疗寒湿凝滞型痛经的持续疗效越佳。(7)四组在第6个月随访的CMSS痛经症状程度总分比较A组与C组、A组与D组、B组与C组、B组与D组、C组与D组在3个月都有明显的差异(P0.05),而A组与B组没有显着性差异(P0.05),提示温针灸配合中药治疗比单纯用中药治疗优胜,而且经前5天及3天介入温针灸的持续疗效优于经行第1天介入温针灸。结论(1)不同时间温针灸配合中药治疗及单纯中药治疗均能显着改善患者疼痛及痛经伴随症状的发作频率和程度,说明通过内服中药和温针灸手段治疗寒湿凝滞型痛经有确切的疗效;针药并施的互补作用能弥补单一方法的限制,并能提高经行腹痛及经行伴随症状发作频率、程度上的改善幅度。(2)不同的温针灸介入时间对于治疗寒湿凝滞型痛经的疗效有显着性差异,经前5天及3天介入温针灸配合中药治疗的疗效及持续疗效比经行第1天温针灸配合中药的持续疗效较佳;经前5天介入温针灸比经前3天介入温针灸治疗痛经症状频率的持续疗效明显优胜,说明越早介入温针灸治疗寒湿凝滞型痛经的持续疗效越佳。
[Abstract]:Objective (1) in this study, clinical randomized controlled trial was used to observe the clinical effect of warm acupuncture combined with traditional Chinese medicine on cold dampness and stagnation of dysmenorrhea at different time, and to explore the best intervention time of warm moxibustion combined with traditional Chinese medicine in treating cold dampness and stagnation type dysmenorrhea. (2) compare different time temperature acupuncture and moxibustion with traditional Chinese medicine and pure Chinese medicine in treating cold wet stagnation type dysmenorrhea The curative effect difference was provided to provide the basis for the treatment scheme for the clinical optimization of dysmenorrhea. Methods the subjects from the Hongkong TCM Comprehensive Center of Hongkong were divided into four groups according to the 1:1:1:1 proportion, 32 cases in the first 5 days of warm acupuncture + Chinese medicine group (group A), and the 3 days of warm acupuncture plus Chinese medicine group (group B) 32. There were 33 cases of first days warm acupuncture plus Chinese medicine group (group C) and 33 cases of group.A in blank control group (group D): warm acupuncture and moxibustion began 5 days before menstruation, 1 times a day, 5 days for continuous treatment, and 3 menstrual cycles were continuously treated. The ground machine (double), water channel (double), return (double), use "south of the Five Ridges Chen's needle method" to swiftly rotate into the needle, ground machine, waterway, return to use big purgative method, the rest acupoint use flat reinforcing and leveling technique make it get gas, and then a section of a length about 2cm of a section on each needle handle, and prepare a 2*3cm big hard paper piece, cut open one end on the needle body, obstruct To avoid the skin of the acupoint at the acupoint of the burn, the acupuncture point has a warm feeling in the course of the treatment. When the section is burned out, the needle is removed and the whole treatment time is 20 minutes. The 1 time, taking 10 days, taking 3 months for a total of 3 months. The method is to put the granules in the container and take the appropriate temperature of the open water about 200 milliliters of the.B group: the warm acupuncture and moxibustion start from the 3 days of the menstruation, 1 times a day, the continuous treatment for 5 days and the continuous treatment of 3 menstrual cycles. The acupuncture prescription and operation are the same as the group of A warm needling, the prescription of traditional Chinese medicine and the prescription and service prescription The method and group A group of traditional Chinese medicine group were the same group.C: warm acupuncture and moxibustion started from first days of menstruation, 1 times a day, continuous treatment for 5 days and continuous treatment of 3 menstrual cycles. The prescription and operation of acupuncture were the same as that in group A. The prescription and the method of Chinese traditional medicine were the same as.D group in group A: the prescription of Chinese medicine and the method of dressing the traditional Chinese medicine were the same as that in the group of A. The four groups of studies were tested. All the patients were asked to fill in the NRS pain score scale and CMSS dysmenorrhea symptom scale for 1,2,3 months and sixth months (follow up months), and evaluate the degree and frequency of the abdominal pain and concomitant symptoms of the experimenters. Each time was collected by the special duty personnel to evaluate the efficacy of each group. All the data were calculated by SPSS24.0 statistics. Results in the process of statistical analysis, 2 cases were lost in group A, 2 cases in group B, 3 cases in group C, 3 cases in group D, 120 in group D, of which 30 cases in group A, 30 in group B, 30 in C group, 30 in D group. (1) before treatment, the score of NRS pain score was scored before treatment, and the frequency of CMSS pain of dysmenorrhea symptoms was total. There was no statistical significance (P0.05) between the scores and the total scores. (2) the NRS pain score of the four groups before and 3 months after treatment was repeated analysis of variance, A group test results P=0.01 (0.05), B group test results P=0.01 (0.05), C group test results P=0.03 (0.05), D group test Results P=0.04 (0.05) (0.05) showed that four groups had obvious analgesic effect for 3 months. The analgesic effect of group A and group B was better than group C and group D, which indicated that the effect of interventional warm acupuncture and acupuncture combined with traditional Chinese medicine before the first 5 days and 3 days was better than the first days of interventional warm acupuncture combined with traditional Chinese medicine treatment and pure Chinese medicine treatment. (3) the total effective rate of the NRS pain score scale of the NRS was A. The total effective rate was 96.67%, the total effective rate in group B was 90%, and the total effective rate of group D was 90%, and the total effective rate of group D was very significant (P0.01) after the treatment of 76.67%. four cases. (4) there was no statistical difference between the four groups in the total score of CMSS dysmenorrhea symptoms in the treatment of 1,2,3 months, the difference between the A group and the B group was not statistically significant (P0.05). Group and D group, group B and C, B group and D group, C group and D group have obvious difference (P0.05) at 3 months (P0.05). It suggests that warm acupuncture combined with traditional Chinese medicine is better than traditional Chinese medicine, and the effect of interventional warm acupuncture at the first 5 days and 3 days is better than that of interventional warm acupuncture at first days. (5) the total score ratio of CMSS in the four group in the treatment of CMSS for CMSS. The difference between group A and group B was not statistically significant (P0.05); in group A and C group, group A and D group, B group and C group, B group and D group, C group and group were obviously different in 3 months, suggesting that warm acupuncture combined with traditional Chinese medicine is better than traditional Chinese medicine, and the effect of interventional warm acupuncture at the first 5 days and 3 days is superior to first days' interventional warm acupuncture. (6) The total scores of dysmenorrhea symptoms in the four groups were compared in group A and group B, group A and group B, group A and C, group A and D, B and C, B group and D group, C group and group in 3 months, suggesting that warm acupuncture combined with traditional Chinese medicine is better than traditional Chinese medicine, and the continuous effect of acupuncture and moxibustion at the first 5 days is better than the first 3 days The curative effect of interventional therapy was better than that of first days of warming acupuncture and moxibustion in the first 3 days. It was suggested that the better the continuous effect of the earlier intervention of warm acupuncture and moxibustion for cold dampness and stagnation of dysmenorrhea. (7) the total scores of CMSS dysmenorrhea in the four groups were compared with group A and C, group A and D, group B and C, B group and D group, C group and D. There were significant differences in the 3 months (P0.05), but there was no significant difference between group A and group B (P0.05), suggesting that warm acupuncture combined with traditional Chinese medicine is better than traditional Chinese medicine, and the continuous effect of interventional warm acupuncture at the first 5 days and 3 days is superior to that of the menstrual first days. (1) different time temperature acupuncture and moxibustion combined with traditional Chinese medicine and pure Chinese Medicine Drug therapy can significantly improve the frequency and degree of pain and dysmenorrhea associated symptoms in patients, indicating that the treatment of cold dampness and stagnation of dysmenorrhea through Chinese medicine and warm acupuncture can make up for the limitation of the single method, and can improve the frequency of abdominal pain and the incidence of accompanying symptoms. (2) there is a significant difference in the therapeutic effect of different warm acupuncture and moxibustion intervention time on the treatment of cold dampness and stagnation of dysmenorrhea. The curative effect and continuous effect of interventional warm moxibustion combined with traditional Chinese medicine in the first 5 days and 3 days is better than that of traditional Chinese medicine with first days of acupuncture and moxibustion combined with traditional Chinese medicine; the intervention of warm acupuncture and moxibustion at the first 5 days is more than 3 days prior to the treatment of warm acupuncture and moxibustion. The continuous curative effect of the frequency of dysmenorrhea symptoms was significantly better, indicating that the earlier the intervention, the better the sustained curative effect of warming needle moxibustion in the treatment of dysmenorrhea.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R246.3

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