灸法治療原發(fā)性痛經(jīng)的文獻(xiàn)挖掘及臨床隨機(jī)對(duì)照研究
發(fā)布時(shí)間：2019-02-15 09:06
【摘要】：目的： 本研究運(yùn)用文獻(xiàn)研究、臨床調(diào)研、專家咨詢、論證等方法,全面整理灸法治療原發(fā)性痛經(jīng)的研究進(jìn)展,并通過(guò)科學(xué)、規(guī)范的臨床研究設(shè)計(jì),對(duì)灸法治療原發(fā)性痛經(jīng)進(jìn)行臨床評(píng)價(jià),以建立證據(jù)確鑿、可供推廣的優(yōu)化治療方案,為中醫(yī)非藥物療法-—灸法治療原發(fā)性痛經(jīng)的臨床推廣應(yīng)用提供客觀依據(jù)。 方法： 1.采用數(shù)據(jù)挖掘技術(shù)全面收集古今中外有關(guān)單純運(yùn)用灸法治療原發(fā)性痛經(jīng)的專著文獻(xiàn)和期刊文獻(xiàn),建立相應(yīng)古代文獻(xiàn)和現(xiàn)代文獻(xiàn)數(shù)據(jù)庫(kù)；結(jié)合臨床調(diào)研、專家咨詢、論證等方法確定選穴、灸法、操作、療程等治療方案的內(nèi)容。 2.采用隨機(jī)數(shù)字表將患者分為A組(艾條溫和灸組)、B組(口服芬必得組),每組各76例。其中脫落和剔除的病人共19人,最終A組69人、B組64人完成三個(gè)月經(jīng)周期的治療。療效評(píng)價(jià)標(biāo)準(zhǔn)為：(1)治療前后組內(nèi)和組間VAS評(píng)分的分值變化；(2)治療前后組內(nèi)及組間的COX痛經(jīng)癥狀量表評(píng)分變化；(3)前列腺素F2。(PGF2。)、催產(chǎn)素(OT)檢查的前后數(shù)值變化。 結(jié)果： 1.文獻(xiàn)部分： (1)古代文獻(xiàn)部分：治療痛經(jīng)穴位論述中選穴次數(shù)排名前三位的是關(guān)元、中極、三陰交。任脈與足少陰腎經(jīng)為選穴頻次最多的經(jīng)脈。 (2)現(xiàn)代文獻(xiàn)部分：最常使用的施灸方式是艾炷灸,其次為艾條灸。最常使用排名前三位的腧穴是：關(guān)元、神闕、三陰交/中極。腧穴的經(jīng)脈分布最多的為任脈與足太陽(yáng)膀胱經(jīng)。現(xiàn)代文獻(xiàn)中選用最多的主穴是關(guān)元、神闕、中極；主穴的十四經(jīng)歸屬中,任脈使用頻次最多。灸法多用于治療實(shí)證且寒濕凝滯型與氣滯血瘀型的研究最多。治療多從經(jīng)前7天開(kāi)始,月經(jīng)來(lái)潮時(shí)結(jié)束,7天一療程,一般治療3個(gè)療程,隨訪3個(gè)月。 2.臨床部分： ①組內(nèi)治療前后VAS評(píng)分結(jié)果：兩組組內(nèi)治療前后各次VAS兩兩對(duì)比統(tǒng)計(jì)結(jié)果,P小于0.01,具有顯著的統(tǒng)計(jì)學(xué)差異。 ②組內(nèi)治療前后COX痛經(jīng)癥狀量表評(píng)分結(jié)果： A.癥狀發(fā)作總時(shí)間：A組治療前后各次評(píng)估P值均小于0.01；B組,第一次與第二次治療后的比值為P小于0.05,其余對(duì)比P值均小于0.01。 B.癥狀嚴(yán)重程度：艾灸組三次治療后與基線期比較,惡心、嘔吐、食欲不振、背(腰骼部)痛、腿痛、乏力、眩暈、腹瀉、面色變化、失眠、易激惹的P小于0.01;·頭痛、抑郁、神經(jīng)質(zhì)的P小于0.05。西藥組食欲不振、背(腰骼部)痛、乏力、腹瀉、面色變化、失眠、全身疼痛的P小于0.01；惡心、嘔吐、頭痛、腿痛、胃痛、易激惹的P小于0.05。 ③兩組VAS評(píng)分對(duì)比結(jié)果：兩組在基線期和第三次治療后評(píng)分P大于0.05；西藥組在第一次治療與第二次治療后的評(píng)分P小于0.01。 ④兩組COX痛經(jīng)癥狀量表對(duì)比結(jié)果：三個(gè)月的治療后,艾灸組比西藥組在食欲不振、神經(jīng)質(zhì)方面具有明顯優(yōu)勢(shì),P小于0.01；腹瀉、抑郁方面,P小于0.05。 ⑤兩組部分受試者前列腺素,(PGF2.).催產(chǎn)素(OT)組間比較無(wú)統(tǒng)計(jì)學(xué)差異。 ⑥兩組組內(nèi)隨訪期與第三個(gè)月經(jīng)周期相比,艾灸組P大于0.05;西藥組VA S、COX的小腹部疼痛癥狀,出現(xiàn)統(tǒng)計(jì)學(xué)差異,表明療效下降。組間比較無(wú)統(tǒng)計(jì)學(xué)差異。. 結(jié)論： 1.古今文獻(xiàn)挖掘結(jié)果表明：關(guān)元、神闕、三陰交是古今文獻(xiàn)中最常用于治療痛經(jīng)的穴位；寒濕凝滯型和氣滯血瘀型是艾灸治療的優(yōu)選證型；經(jīng)前七天左右介入灸法治療的療效肯定。 2.艾灸組和西藥組的組內(nèi)各次治療的兩兩比較均有效,且兩組各次治療后的痛經(jīng)伴隨癥狀改善各有偏重。兩組組內(nèi)OT的分值均有明顯降低。 3.相對(duì)于西藥組在第一、二次治療后鎮(zhèn)痛即發(fā)揮明顯的優(yōu)勢(shì),艾灸組的治療起效更緩慢持久,在持續(xù)三個(gè)月經(jīng)周期的治療之后,可達(dá)到與西藥組相同的鎮(zhèn)痛作用,并且在緩解食欲不振、神經(jīng)質(zhì)、腹瀉、抑郁方面比西藥組效果更好。兩組組間在降低PGF2。、OT方面的比較沒(méi)有明顯差異。 4.隨訪期：艾灸組的療效持續(xù)在隨訪第一個(gè)月經(jīng)周期較西藥組好,表明艾灸在效果的持續(xù)及穩(wěn)定方面比西藥組更好。
[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
【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類號(hào)】：R246.3
本文編號(hào)：2423177
[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
【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類號(hào)】：R246.3
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