本文選題：不同時(shí)間 + 溫針灸　； 參考：《廣州中醫(yī)藥大學(xué)》2017年博士論文

【摘要】：目的(1)本研究采用臨床隨機(jī)對(duì)照試驗(yàn)觀察不同時(shí)間介入溫針灸配合中藥治療寒濕凝滯型痛經(jīng)的臨床效果,探究溫針灸配合中藥治療寒濕凝滯型痛經(jīng)的最佳介入時(shí)間。(2)比較不同時(shí)間溫針灸配合中藥及單純中藥治療寒濕凝滯型痛經(jīng)的療效差異,為臨床優(yōu)化痛經(jīng)的治療方案提供依據(jù)。方法受試者來源于香港中醫(yī)綜合中心的病人,將符合本研究納入標(biāo)準(zhǔn)的130例觀察對(duì)象,采用隨機(jī)分組,按1:1:1:1比例分為四組:經(jīng)前5天溫針灸+中藥組(A組)32例、經(jīng)前3天溫針灸+中藥組(B組)32例、經(jīng)行第1天溫針灸+中藥組(C組)33例和中藥空白對(duì)照組(D組)33例。A組:溫針灸從月經(jīng)來潮前5天開始,每日治療1次,連續(xù)治療5天,連續(xù)治療3個(gè)月經(jīng)周期。針刺用具采用一次性不銹鋼無菌針,規(guī)格為0.25*40mm。針刺處方選用中極、關(guān)元、三陰交(雙)、地機(jī)(雙)、水道(雙)、歸來(雙),采用"嶺南陳氏針法"快速旋轉(zhuǎn)進(jìn)針,地機(jī)、水道、歸來采用大瀉法,其余穴位采用平補(bǔ)平瀉手法使其得氣,然后將一段長(zhǎng)約2cm的艾段點(diǎn)燃插在每支針柄上,并準(zhǔn)備2*3cm大的硬紙片一張,剪開一端套在針體上,阻隔艾段避免燒傷腧穴處的皮膚,以治療過程中溫針灸的穴位有溫?zé)岣袨槎取．?dāng)艾段燃盡后拔針除去灰燼,整個(gè)治療時(shí)間為20分鐘。中藥服法:服用中藥顆粒沖劑,方為少腹逐瘀湯加蒼術(shù)、茯苓,在月經(jīng)前5天服用,至月經(jīng)來潮第5天停服,每日服用1次,共服10天,連續(xù)服用3個(gè)月。沖服法是將中藥顆粒放在容器內(nèi),用合適溫度的開水約200毫升沖服。B組:溫針灸從月經(jīng)來潮前3天開始,每日治療1次,連續(xù)治療5天,連續(xù)治療3個(gè)月經(jīng)周期。針刺處方及操作與A組溫針組相同,中藥處方及沖服方法與A組中藥組相同。C組:溫針灸從月經(jīng)來潮第1天開始,每日治療1次,連續(xù)治療5天,連續(xù)治療3個(gè)月經(jīng)周期。針刺處方及操作與A組溫針組相同,中藥處方及沖服方法與A組中藥組相同。D組:中藥處方及沖服方法與A組中藥組相同。四組研究試驗(yàn)者均要求在治療前、治療1,2,3個(gè)月、第6個(gè)月(隨訪月)填寫NRS疼痛評(píng)分量表及CMSS痛經(jīng)癥狀量表,對(duì)試驗(yàn)者的經(jīng)行腹痛及經(jīng)行伴隨癥狀在程度及頻率分?jǐn)?shù)進(jìn)行評(píng)估,每次由專責(zé)人員收集量表,客觀地評(píng)估各組療效。所有資料均采用SPSS24.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)分析。結(jié)果治療過程中A組脫落2例,B組脫落2例,C組脫落3例,D組脫落3例,實(shí)際完成臨床觀察病例120個(gè),其中A組30例,B組30例,C組30例,D組30例。(1)治療前分別對(duì)四組年齡、病程、治療前NRS疼痛評(píng)分量表評(píng)分、CMSS痛經(jīng)癥狀發(fā)作頻率總分及程度總分進(jìn)行基線分析,各組間比較差別無統(tǒng)計(jì)學(xué)意義(P0.05),具有可比性。(2)四組治療前與治療3個(gè)月的NRS疼痛評(píng)分量表評(píng)分經(jīng)過重復(fù)測(cè)量的方差分析,A組檢驗(yàn)結(jié)果P=0.01(0.05),B組檢驗(yàn)結(jié)果P=0.01(0.05),C 組檢驗(yàn)結(jié)果 P=0.03(0.05),D 組檢驗(yàn)結(jié)果 P=0.04(0.05),說明四組治療3個(gè)月有明顯的止痛效果,其中A組,B組的止痛效果優(yōu)于C組,D組,說明經(jīng)前5天及3天介入溫針灸配合中藥的療效優(yōu)于經(jīng)行第1天介入溫針灸配合中藥治療及單純中藥治療。(3)四組NRS疼痛評(píng)分量表評(píng)分總有效率A組總有效率為96.67%;B組總有效率為93.33%。C組總有效率為90.00%;D組總有效率為76.67%。四組病例治療后的NRS療效比較有極顯著性差異(P0.01)。(4)四組在治療1,2,3個(gè)月的CMSS痛經(jīng)癥狀頻率總分比較A組與B組的差異沒有統(tǒng)計(jì)學(xué)意義(P0.05);A組與C組、A組與D組、B組與C組、B組與D組、C組與D組在3個(gè)月都有明顯的差異(P0.05),提示溫針灸配合中藥治療比單純用中藥治療優(yōu)勝,而且經(jīng)前5天及3天介入溫針灸的療效優(yōu)于經(jīng)行第1天介入溫針灸。(5)四組在治療第1,2,3個(gè)月的CMSS痛經(jīng)癥狀程度總分比較A組與B組的差異沒有統(tǒng)計(jì)學(xué)意義(P0.05);A組與C組、A組與D組、B組與C組、B組與D組、C組與D組在3個(gè)月都有明顯的差異(P0.05),提示溫針灸配合中藥治療比單純用中藥治療優(yōu)勝,而且經(jīng)前5天及3天介入溫針灸的療效優(yōu)于經(jīng)行第1天介入溫針灸。(6)四組在第6個(gè)月隨訪的CMSS痛經(jīng)癥狀頻率總分比較A組與B組、A組與C組、A組與D組、B組與C組、B組與D組、C組與D組在3個(gè)月都有明顯的差異(P0.05),提示溫針灸配合中藥治療比單純用中藥治療優(yōu)勝,而且經(jīng)前5天介入溫針灸的持續(xù)療效優(yōu)于經(jīng)前3天介入的持續(xù)療效,經(jīng)前3天介入溫針灸的療效優(yōu)于經(jīng)行第1天介入溫針灸的療效,提示越早介入溫針灸治療寒濕凝滯型痛經(jīng)的持續(xù)療效越佳。(7)四組在第6個(gè)月隨訪的CMSS痛經(jīng)癥狀程度總分比較A組與C組、A組與D組、B組與C組、B組與D組、C組與D組在3個(gè)月都有明顯的差異(P0.05),而A組與B組沒有顯著性差異(P0.05),提示溫針灸配合中藥治療比單純用中藥治療優(yōu)勝,而且經(jīng)前5天及3天介入溫針灸的持續(xù)療效優(yōu)于經(jīng)行第1天介入溫針灸。結(jié)論(1)不同時(shí)間溫針灸配合中藥治療及單純中藥治療均能顯著改善患者疼痛及痛經(jīng)伴隨癥狀的發(fā)作頻率和程度,說明通過內(nèi)服中藥和溫針灸手段治療寒濕凝滯型痛經(jīng)有確切的療效;針?biāo)幉⑹┑幕パa(bǔ)作用能彌補(bǔ)單一方法的限制,并能提高經(jīng)行腹痛及經(jīng)行伴隨癥狀發(fā)作頻率、程度上的改善幅度。(2)不同的溫針灸介入時(shí)間對(duì)于治療寒濕凝滯型痛經(jīng)的療效有顯著性差異,經(jīng)前5天及3天介入溫針灸配合中藥治療的療效及持續(xù)療效比經(jīng)行第1天溫針灸配合中藥的持續(xù)療效較佳;經(jīng)前5天介入溫針灸比經(jīng)前3天介入溫針灸治療痛經(jīng)癥狀頻率的持續(xù)療效明顯優(yōu)勝,說明越早介入溫針灸治療寒濕凝滯型痛經(jīng)的持續(xù)療效越佳。
[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.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R246.3

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