灸法治疗原发性痛经的文献挖掘及临床随机对照研究

发布时间：2019-02-15 09:06

【摘要】：目的：本研究运用文献研究、临床调研、专家咨询、论证等方法,全面整理灸法治疗原发性痛经的研究进展,并通过科学、规范的临床研究设计,对灸法治疗原发性痛经进行临床评价,以建立证据确凿、可供推广的优化治疗方案,为中医非药物疗法-—灸法治疗原发性痛经的临床推广应用提供客观依据。方法： 1.采用数据挖掘技术全面收集古今中外有关单纯运用灸法治疗原发性痛经的专著文献和期刊文献,建立相应古代文献和现代文献数据库；结合临床调研、专家咨询、论证等方法确定选穴、灸法、操作、疗程等治疗方案的内容。 2.采用随机数字表将患者分为A组(艾条温和灸组)、B组(口服芬必得组),每组各76例。其中脱落和剔除的病人共19人,最终A组69人、B组64人完成三个月经周期的治疗。疗效评价标准为：(1)治疗前后组内和组间VAS评分的分值变化；(2)治疗前后组内及组间的COX痛经症状量表评分变化；(3)前列腺素F2。(PGF2。)、催产素(OT)检查的前后数值变化。结果： 1.文献部分： (1)古代文献部分：治疗痛经穴位论述中选穴次数排名前三位的是关元、中极、三阴交。任脉与足少阴肾经为选穴频次最多的经脉。 (2)现代文献部分：最常使用的施灸方式是艾炷灸,其次为艾条灸。最常使用排名前三位的腧穴是：关元、神阙、三阴交/中极。腧穴的经脉分布最多的为任脉与足太阳膀胱经。现代文献中选用最多的主穴是关元、神阙、中极；主穴的十四经归属中,任脉使用频次最多。灸法多用于治疗实证且寒湿凝滞型与气滞血瘀型的研究最多。治疗多从经前7天开始,月经来潮时结束,7天一疗程,一般治疗3个疗程,随访3个月。 2.临床部分： ①组内治疗前后VAS评分结果：两组组内治疗前后各次VAS两两对比统计结果,P小于0.01,具有显著的统计学差异。 ②组内治疗前后COX痛经症状量表评分结果： A.症状发作总时间：A组治疗前后各次评估P值均小于0.01；B组,第一次与第二次治疗后的比值为P小于0.05,其余对比P值均小于0.01。 B.症状严重程度：艾灸组三次治疗后与基线期比较,恶心、呕吐、食欲不振、背(腰骼部)痛、腿痛、乏力、眩晕、腹泻、面色变化、失眠、易激惹的P小于0.01;·头痛、抑郁、神经质的P小于0.05。西药组食欲不振、背(腰骼部)痛、乏力、腹泻、面色变化、失眠、全身疼痛的P小于0.01；恶心、呕吐、头痛、腿痛、胃痛、易激惹的P小于0.05。 ③两组VAS评分对比结果：两组在基线期和第三次治疗后评分P大于0.05；西药组在第一次治疗与第二次治疗后的评分P小于0.01。 ④两组COX痛经症状量表对比结果：三个月的治疗后,艾灸组比西药组在食欲不振、神经质方面具有明显优势,P小于0.01；腹泻、抑郁方面,P小于0.05。 ⑤两组部分受试者前列腺素,(PGF2.).催产素(OT)组间比较无统计学差异。 ⑥两组组内随访期与第三个月经周期相比,艾灸组P大于0.05;西药组VA S、COX的小腹部疼痛症状,出现统计学差异,表明疗效下降。组间比较无统计学差异。. 结论： 1.古今文献挖掘结果表明：关元、神阙、三阴交是古今文献中最常用于治疗痛经的穴位；寒湿凝滞型和气滞血瘀型是艾灸治疗的优选证型；经前七天左右介入灸法治疗的疗效肯定。 2.艾灸组和西药组的组内各次治疗的两两比较均有效,且两组各次治疗后的痛经伴随症状改善各有偏重。两组组内OT的分值均有明显降低。 3.相对于西药组在第一、二次治疗后镇痛即发挥明显的优势,艾灸组的治疗起效更缓慢持久,在持续三个月经周期的治疗之后,可达到与西药组相同的镇痛作用,并且在缓解食欲不振、神经质、腹泻、抑郁方面比西药组效果更好。两组组间在降低PGF2。、OT方面的比较没有明显差异。 4.随访期：艾灸组的疗效持续在随访第一个月经周期较西药组好,表明艾灸在效果的持续及稳定方面比西药组更好。
[Abstract]:Purpose: This study uses the methods of literature research, clinical investigation, expert consultation, demonstration and so on. The research progress of the treatment of primary dysmenorrhea is treated by means of the comprehensive treatment and moxibustion, and the clinical evaluation of the treatment of primary dysmenorrhea is carried out by the scientific and standard clinical study. The price is set to establish an optimized treatment plan, which can be used for promotion, and provides objective basis for the clinical application and application of the traditional Chinese medicine non-drug therapy-acupuncture and moxibustion method in the treatment of primary dysmenorrhea. It was reported. Methods: 1. Data mining was used to comprehensively collect the monographs and the journal articles about the treatment of primary dysmenorrhea by using the moxibustion, and to establish the corresponding ancient literature and the modern literature database; and in combination with the clinical investigation, the expert consultation, the demonstration and other methods. Treatment of selected points, moxibustion, operation, treatment course, etc. The contents of the scheme were as follows: 2. The patients were divided into group A (moxa-mild moxibustion group) and group B (oral Fenhe group) by using a random number table. There were 19 patients in each group, including 19 patients, 69 in the final A group and 64 in group B. The treatment of the menstrual cycle: (1) the score change of the VAS score in the group and the group before and after treatment; (2) the change of the score of the COX-3 symptom scale in the group and group before and after treatment; (3)) Prostaglandin F 2. (PGF2.), Oxytocin (OT) before and after Numerical change. Results: 1. The part of the literature: (1) The part of ancient literature: the number of selected points in the treatment of dysmenorrhea. The three of them are Guan Yuan, the middle and the third and the third and the third and the third and the third. The most frequently used channels of yin and kidney meridians. (2) Modern literature: most commonly used. The mode of moxibustion is moxibustion, followed by moxibustion. The most frequent use of the top three is the top three. The point is: guan yuan, god's hand, three yin and the middle and the other. The most distributed is the meridians and the meridian passage of the foot. The most important points in the modern literature are guan yuan, god's hand, middle pole, and main point. 14. The most frequent use frequency of Ren Mai is in the attribution. The moxibustion method is used for the treatment of positive and cold. The study of wet-type stagnation type and qi stagnation and blood stasis type is the most. The treatment is more than 7 days from the first 7 days, and the period of 7 days is a course of treatment., in general, 3 treatment Treatment course, follow-up for 3 months. 2. Clinical part: VAS score before and after treatment in the two-group group: two comparative statistical results of the VAS in the two groups before and after treatment P <0.01, with significant statistical difference. The score of COX-2 after treatment before and after treatment in the treatment group: A. Total time of the symptom onset: the P-value of each sub-evaluation before and after the treatment of group A was less than 0.01; group B, the ratio of the first and the second treatment The value of P was less than 0.05, and the other P values were less than 0.01. B. The severity of symptoms: The moxibustion group was compared with the baseline period after three treatments, nausea, vomiting, inappetence, back (waist and throat) pain, leg pain, asthenia, vertigo, diarrhea, color change, insomnia, and irritability. It was less than 0.01; headache, depression, and neurotic P were less than 0.05. The western medicine group had no appetite, and the back (waist and stomach) pain, asthenia, diarrhea, color change, insomnia, and general pain were less than 0.01; evil The scores of heart, vomiting, headache, leg pain, stomachache and irritability were less than 0.05. The results of the comparison of VAS scores between the two groups were as follows: the scores of the two groups after the baseline and the third treatment were greater than 0.05. After the first treatment and the second treatment, the score of the first treatment and the second treatment was less than 0.01. The results of the comparison of the two groups of COX-2 in the two groups: after three months of treatment, the moxibustion group compared with the western medicine group in the aspect of inappetence and neuroticism. has obvious advantages, P is less than 0.01, diarrhea, depression, In the aspect, P is less than 0.05. The two groups of the two groups are tested There was no statistical difference between the group of the two groups of the two groups (P> 0.05). Small dose of VA S and COX in western medicine group abdominal pain There is no statistical difference in the symptoms of pain. There is no statistical difference between the groups. There is no statistical difference between the groups. Conclusion: 1. The results of the excavation of the ancient and modern documents show that: Guan, Shen, and Sanyin are the most commonly used points for the treatment of dysmenorrhea in the ancient and modern literature; the cold-dampness The stagnation type and qi stagnation and blood stasis type are the preferred type of moxibustion treatment; the curative effect of the treatment with the intervention moxibustion at the left and right of the first seven days is positive. The two comparisons of the treatment in the group of the drug group were both In the first and second treatment, the treatment effect of moxibustion group was more slow and lasting, and in the last three months, the treatment effect of moxibustion group was more slow and lasting. after the treatment of the menstrual cycle, has the same analgesic effect as the western medicine group, and can be used for relieving inappetence, nervousness, abdomen, The effect of diarrhea and depression was better than that of the western medicine group. There was no significant difference between the two groups in the reduction of PGF2. The follow-up period: moxibustion
【学位授予单位】：成都中医药大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R246.3

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