本文關鍵詞：電針臍周四穴為主加麥粒灸促排卵效應的臨床療效觀察　出處：《廣州中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 臍周四穴 麥粒灸 河圖 促排卵效應

【摘要】：目的:觀察針刺聯(lián)合麥粒灸促排卵效應的臨床療效,評價并觀察以培土健脾為理論基礎的針刺方法的臨床有效性,并初步探討其作用機理,為證明針刺聯(lián)合麥粒灸促排卵、改善子宮內(nèi)膜厚度的優(yōu)勢提供參考。方法:將60例患者采用隨機對照的方法分成兩組,其中針灸組及西藥組各30例,在月經(jīng)周期第5天行下列治療:1、針刺組:主穴:天樞(雙)、水分、陰交、歸來、足三里、三陰交配穴:氣滯血瘀加血海、太沖;濕熱下注加水道、次毼;血虛宮寒加關元、命門;痰濁瘀阻加陰陵泉、豐隆。腹部麥粒灸操作方法:取5mg左右精細艾絨,制成上尖、中粗、下尖而平便于放置的艾粒,直徑約2mmm,高度約3mm,將相應穴位涂以藥汁(該藥汁為麥粒灸特效藥汁,源自香港政府化驗師張超翰醫(yī)師家族傳承)后,放置于體表,以線香點燃艾柱頂端,待患者覺局部灼痛后,以拇指指甲按壓艾柱使其熄滅,以相同方法灸下一穴位。待灸法完成后5min去掉殘余艾柱。以河圖圖式為理論基礎,施灸穴位為:數(shù)字1施灸關元穴;點數(shù)2施灸雙側(cè)石關穴;點數(shù)3施灸滑肉門、天樞、外陵穴(均右側(cè));點數(shù)4施灸足陽明胃經(jīng)的滑肉門至外陵穴之間(均左側(cè));點數(shù)5施灸水分、陰交、雙側(cè)肓俞,神闕穴僅作為取穴標志,不灸;點數(shù)6施灸雙側(cè)歸來、雙側(cè)大赫、雙側(cè)府舍;點數(shù)7施灸雙側(cè)梁門、雙側(cè)陰都、中脘、梁門與陰都穴中點各施灸1壯;點數(shù)8、點數(shù)9以足太陰脾經(jīng)為主,以腹哀穴、腹結(jié)穴為起止,均勻分布于腹部兩側(cè)之脾經(jīng);點數(shù)10在北方施灸大巨、四滿、臍下1寸處、南方施灸太乙、商曲、臍上2寸處。針刺治療完畢后立即予以腹部麥粒灸治療,隔日治療一次,連續(xù)治療一個月為1個療程,共治療3個療程。在月經(jīng)或陰道有撤退性出血之第5天開始口服枸櫞酸氯米芬膠囊,每日服用50mg,連用5天。2.西藥組:口服克羅米芬,用法同針灸組。療程中均記錄服藥情況及不良反應。兩組各治療觀察3個月經(jīng)周期,治療期間妊娠者結(jié)束治療。治療前后記錄患者年齡、病程、中醫(yī)辨證分型、子宮內(nèi)膜厚度、SDS抑郁量表、排卵次數(shù)和妊娠情況來進行臨床療效的評價。結(jié)果:兩組患者在治療期間均無脫落和剔除病例。兩組患者治療前在年齡、病程、中醫(yī)辨證分型方面,P值均大于0.05,差異無統(tǒng)計學意義,表明兩組患者在治療前具有可比性。治療前,針灸組SDS評分為44.63±11.49,西藥組SDS評分為48.50±12.54,兩組間經(jīng)t檢驗,差異無統(tǒng)計學意義(P=0.220.05);治療后,針灸組SDS評分為40.00±9.72,西藥組SDS評分為46.27±9.45,兩組治療后SDS評分與治療前相比均有明顯差異(P0.05);比較治療后兩組間SDS評分,有明顯的差異(P=0.020.05),總而言之,兩種治療方法均可降低患者的SDS評分,并且針灸組降低SDS評分方面優(yōu)于西藥組。治療前,針灸組子宮內(nèi)膜厚度為6.63±1.16,西藥組子宮內(nèi)膜厚度為6.50±1.53。經(jīng)兩獨立樣本t檢驗,P=0.700.05,表明兩組患者治療前子宮內(nèi)膜厚度差異無統(tǒng)計學意義。針灸組患者自身前后對比,經(jīng)配對樣本t檢驗,t=-5.12;西藥組患者自身前后對比,經(jīng)配對樣本t檢驗,t=-2.60,兩組p值均0.05,差異具有統(tǒng)計學意義,也就是兩種治療方法均可以促進子宮內(nèi)膜增長。兩組患者在治療后的子宮內(nèi)膜厚度經(jīng)獨立樣本t檢驗,t=-0.13,p=0.890.05,說明針灸組在改善內(nèi)膜厚度方面與西藥組療效相當。治療前兩組患者排卵次數(shù)不符合正態(tài)分布,經(jīng)秩和檢驗,p0.05,表明兩組患者治療前排卵次數(shù)差異不具有統(tǒng)計學意義。治療后,經(jīng)秩和檢驗,兩組患者的排卵次數(shù)與治療前對比,P均0.05,表明兩種治療方法均可顯著改善患者的排卵情況。治療后兩組患者排卵次數(shù)比較不滿足正態(tài)分布,經(jīng)秩和檢驗。治療后兩組排卵次數(shù)比較P0.05,差異具有統(tǒng)計學意義,說明在增加排卵次數(shù)方面針灸組優(yōu)于西藥組。治療后兩組妊娠率比較采用卡方檢驗,P0.05,差異無統(tǒng)計學意義,說明治療后兩組妊娠率比較無統(tǒng)計學意義,兩者在改善妊娠結(jié)局方面療效相當。結(jié)論:以培土健脾為理念的針刺聯(lián)合腹部以河圖為理論基礎的麥粒灸治療方法在改善排卵障礙性不孕患者的抑郁狀況、子宮內(nèi)膜厚度、排卵數(shù)目方面及中醫(yī)癥候方面較單純服用西藥有優(yōu)勢,并且為一種安全有效的輔助受孕的方法。
[Abstract]:Objective: To observe the clinical effect of acupuncture combined with moxibustion ovulation effect, evaluation and clinical efficacy of acupuncture method in the spleen as the theoretical basis of the earth, and to explore its mechanism, to provide reference for the proof of the advantages of acupuncture combined with moxibustion ovulation, improve the endometrial thickness. Methods: 60 cases of patients using randomized controlled methods were divided into two groups, acupuncture group and Western medicine group of 30 cases, in the menstrual cycle fifth days following treatment: 1, acupuncture group: the main points: Tianshu (double), moisture, vaginal, back, Zusanli and Sanyinjiao acupoints: Qi stagnation and blood stasis and blood, Taichong; damp heat, blood deficiency and water He; cold house plus Guanyuan, Mingmen; phlegm stasis plus Yin Ling Quan, fenglong. Moxibustion abdominal operation method: take about 5mg fine moxa, made sharp, crude, sharp and flat for the placement of the AI particles about 2mmm in diameter, height of about 3mm, the corresponding point of the drug coated with medicine juice (juice moxibustion medicine juice from Hongkong Government Chemist Dr. Zhang Chaohan family), placed on the surface, the top of the column is ignited, as if, when the patients feel local burning pain, pressing the thumb nail moxa make it out, in the same way a acupoint moxibustion. To remove the residual 5min after moxibustion moxa. The painting schema theory as the theoretical basis, moxibustion points: 1 Digital moxibustion Guanyuan point moxibustion; 2 bilateral stone clearance points; 3 point moxibustion, huaroumen, Tianshu acupoint (all right); 4 points moxibustion Yangming foot huaroumen to between the acupoint (both left); 5 points moxibustion moisture, vaginal, bilateral Huangshu, Shenque acupoint not only as a symbol, 6 points moxibustion; moxibustion bilateral back, bilateral, bilateral Dahe fushe; 7 points moxibustion bilateral liangmen and bilateral Yintu, Zhongwan, liangmen and negative points point the moxibustion 1 points, 9 points 8 strong; with foot too Yin spleen, with energy-saving, energy-saving as the starting and ending, evenly distributed in the abdomen on both sides of the spleen by 10 points in the north; moxibustion big giant, four full, 1 inches below the navel, southern moxibustion Taiyi, Shang Qu 2 inches, umbilical. After the acupuncture treatment was completed immediately after the treatment of abdominal wheat grain moxibustion, treatment once every other day, continuous treatment for one month for 1 courses, a total of 3 courses of treatment. There are fifth days of retreat bleeding in oral or vaginal Clomifene Citrate Capsules menstruation, taking 50mg daily for 5 days. 2. western medicine group: oral clomiphene, usage with acupuncture group. Medication and adverse reactions were recorded during the course of treatment. The two groups were treated with 3 menstrual cycles and the treatment was completed during the treatment. Age, course of disease, TCM syndrome differentiation, endometrial thickness, SDS depression scale, ovulation frequency and pregnancy were recorded before and after treatment to evaluate the clinical efficacy. Results: there were no cases of exfoliation and elimination during the treatment of the two groups. Two groups of patients before treatment, in terms of age, course of disease, TCM syndrome differentiation, P values were greater than 0.05, the difference was not statistically significant, indicating that the two groups of patients before treatment is comparable. Before the treatment, acupuncture group SDS score was 44.63 + 11.49, western medicine group, the SDS score was 48.50 + 12.54, between the two groups by t test, the difference was not statistically significant (P=0.220.05); acupuncture group after treatment, the SDS score was 40 + 9.72, western medicine group, the SDS score was 46.27 + 9.45, the two groups after treatment with the SDS score compared with before treatment were significantly different (P0.05); comparison between the two groups after treatment SDS score had significant difference (P=0.020.05), in short, can reduce the two methods for the treatment of patients with SDS score, SDS score and acupuncture group decreased than that of Western medicine group. Before treatment, the thickness of the endometrium in the acupuncture group was 6.63 + 1.16, and the thickness of the endometrium in the western medicine group was 6.50 + 1.53. Two independent samples t test, P=0.700.05, showed that there was no significant difference in the thickness of endometrium before treatment in the two groups. The patients in the acupuncture group were compared before and after matching, paired samples t test, t=-5.12, western medicine group before and after their own contrast, paired samples t test, t=-2.60, two groups of P values were 0.05, the difference was statistically significant, that is, the two treatment methods can promote endometrial growth. The endometrial thickness of the two groups after treatment was tested by independent sample t test, t=-0.13 and p=0.890.05, indicating that the acupuncture group had the same effect as the western medicine group in improving the thickness of the endometrium. The number of ovulation in the two groups did not conform to normal distribution, and the rank sum test, P0.05, showed that there was no statistical difference in the number of ovulation in the two groups before treatment. After treatment, by rank sum test, the number of ovulation in the two groups was compared with that before treatment, P was 0.05, indicating that the two treatments could significantly improve the ovulation of the patients. After treatment, the number of ovulation in the two groups was not satisfied with normal distribution, and the rank sum test was used. After treatment, the number of ovulation in the two groups was P0.05, the difference was statistically significant, indicating that the acupuncture group was better than the western medicine group in increasing the number of ovulation. After treatment, the pregnancy rate of the two groups was compared with chi square test. There was no significant difference in P0.05 between the two groups, indicating that there was no significant difference in the pregnancy rate between the two groups after treatment. Conclusion: moxibustion therapy for spleen earth in painting as the theoretical basis of the concept of abdominal acupuncture combined with improvement in depression, anovulatory infertility patients' endometrial thickness, ovulation number and TCM syndrome compared with simple western medicine has the advantage, and is a safe and effective method of assisted conception.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R246.3

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