本文關(guān)鍵詞： 原發(fā)性痛經(jīng) 翰怡灸 暖宮貼 寒凝血瘀　出處：《廣州中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：痛經(jīng)是指行經(jīng)前后或月經(jīng)期間出現(xiàn)的下腹部及腰骶部痙攣性疼痛,同時可伴有腰酸、墜脹、惡心、嘔吐、手足厥冷、腹瀉及頭痛等不適癥狀,隨月經(jīng)而發(fā),嚴(yán)重者甚至昏厥,嚴(yán)重影響生活質(zhì)量。原發(fā)性痛經(jīng)是婦科常見疾病,又稱功能性痛經(jīng),75%的原發(fā)性痛經(jīng)發(fā)生在初潮后的第1年內(nèi)。我國1980年全國抽樣調(diào)查結(jié)果表明[1],痛經(jīng)發(fā)生率達(dá)33.19%,其中原發(fā)性痛經(jīng)占36.06%,其疼痛輕度占44.6%,中度占38.81%,嚴(yán)重影響工作的重度占14%。翰怡灸是麥粒灸的一種,介于麥粒灸和壓灸之間。因翰怡灸艾柱小,施灸時作用部位小而精確,溫補(bǔ)之力直透穴位,直達(dá)經(jīng)絡(luò)臟腑,療效比其他療法較高。透過熱力迅速刺激穴位,麥粒灸作為藥引使藥力迅速引進(jìn)致各個經(jīng)絡(luò)臟腑。目的:此次臨床研究使用翰怡灸治療寒凝血瘀型原發(fā)性痛經(jīng)并對其進(jìn)行臨床觀察,評估其臨床療效并探討其作用機(jī)理。方法:病例來源選取于2015年1月至2017年2月廣州中醫(yī)藥大學(xué)的學(xué)生;符合診斷為寒凝血瘀型原發(fā)性痛經(jīng)患者共90例,隨機(jī)分為試驗組30例、對照組30例和空白對照組30例。三組患者均于經(jīng)期后一周開始接受治療。試驗組30例患者使用翰怡灸治療三個月經(jīng)周期,治療用品由張超翰醫(yī)師提供。治療時間:每周治療2-3次,于痛經(jīng)發(fā)生疼痛時可給予治療,連續(xù)3個療程,3個療程后觀察療效。對照組30例患者使用暖宮貼治療三個月經(jīng)周期。治療時間:每周使用2-3次,痛經(jīng)發(fā)生疼痛時可使用暖宮貼,連續(xù)3個療程,3個療程后觀察療效�？瞻讓φ战M30例不給予任何治療。觀察時間:3個月經(jīng)周期。觀察其治療前后疼痛程度評分、痛經(jīng)情況評分以及中醫(yī)癥候評分。結(jié)果:1.疼痛程度積分比較:1.1三組治療第三個月疼痛程度積分比較,P0.001,差異有統(tǒng)計學(xué)意義,且顯示治療組積分小于對照組及空白組,對照組積分小于空白組。1.2療程結(jié)束后一個月疼痛程度積分,P0.001,差異有統(tǒng)計學(xué)意義,且顯示治療組積分小于對照組及空白組,對照組積分等于空白組。1.3治療組和對照組治療前和治療第三個月疼痛程度積分比較,P0.05,差異有統(tǒng)計學(xué)意義,且積分小于治療前。1.4治療組和對照組治療第三個月和療程結(jié)束后一個月疼痛程度積分比較,治療組積分差異P0.001,差異有統(tǒng)計學(xué)意義,顯示療程結(jié)束后一個積分小于治療第三個月。1.5治療組和對照組治療前和治療第三個月疼痛程度積分差值比較,P0.001,差異有統(tǒng)計學(xué)意義,且差值均為治療組大于對照組。2.痛經(jīng)情況積分比較:2.1三組治療第三個月痛經(jīng)情況積分比較,P0.001,差異有統(tǒng)計學(xué)意義,且顯示治療組積分小于對照組及空白組,對照組積分小于空白組。2.2療程結(jié)束后一個月痛經(jīng)情況積分,p0.001,差異有統(tǒng)計學(xué)意義,且顯示治療組積分小于對照組及空白組,對照組積分等于空白組。2.3治療組和對照組治療前和治療第三個月痛經(jīng)情況積分比較,P0.001,差異有統(tǒng)計學(xué)意義,顯示積分小于治療前。2.4治療組和對照組治療第三個月和療程結(jié)束后一個月痛經(jīng)情況積分比較,治療組和對照組治積分差異,P0.001,差異有統(tǒng)計學(xué)意義,且顯示治療組療程結(jié)束后一個月痛經(jīng)情況積分小于治療第三個月,對照組療程結(jié)束后一個月痛經(jīng)情況積分大于治療第三個月。2.5治療組和對照組治療前和治療第三個月痛經(jīng)情況積分差值比較,P0.001,差異有統(tǒng)計學(xué)意義,且積分差值均為治療組大于對照組。3.中醫(yī)癥狀積分比較:3.1三組治療第三個月中醫(yī)癥狀積分比較,P0.001,差異有統(tǒng)計學(xué)意義,且顯示治療組積分小于對照組及空白組,對照組積分小于空白組。3.2療程結(jié)束后一個月中醫(yī)癥狀積分,P0.001,差異有統(tǒng)計學(xué)意義,且顯示顯示治療組積分小于對照組及空白組,對照組積分小于空白組。3.3治療組和對照組治療前和治療第三個月中醫(yī)癥狀積分進(jìn)行比較,治療組治療前和治療第三個月中醫(yī)癥狀積分差異有統(tǒng)計學(xué)意義(P0.05),顯示積分小于治療前。3.4治療組和對照組治療第三個月和療程結(jié)束后一個月中醫(yī)癥狀積分比較,治療組積分差異,P0.05,差異有統(tǒng)計學(xué)意義,顯示積分小于治療第三個月。3.5治療組和對照組治療前和治療第三個月中醫(yī)癥狀積分差值比較,P0.001,差異有統(tǒng)計學(xué)意義,且差值均為治療組大于對照組。3.6治療組和對照組治療前和治療第三個月中醫(yī)各癥狀積分差值比較,兩組間經(jīng)前/經(jīng)期小腹怕冷得熱則緩、經(jīng)前/經(jīng)期小腹疼痛、經(jīng)血量少、經(jīng)血色暗、夾血塊、乳房脹痛、手足不溫和惡心嘔吐差值均數(shù)差異,P0.05,有統(tǒng)計學(xué)意義,且治療組差值大于對照組。4三組間臨床療效比較:三組間的臨床療效,結(jié)果顯示三組間臨床療效差異有統(tǒng)計學(xué)意義(P0.001),治療組臨床療效有效率高于對照組和空白組。治療組患者中12例有效,13例顯著,總有效率100%;對照組患者中29例無效,1例有效,總有效率3.3%;空白組患者29例無效,1例有效,總有效率3.3%。5.三組間疼痛療效比較:三組間的疼痛療效,結(jié)果顯示三組間疼痛療效差異有統(tǒng)計學(xué)意義(P0.001),治療組疼痛療效有效率高于對照組和空白組。治療組患者4例痊愈,5例顯著,14例有效,2例無效,總有效率92%;對照組9例有效,21例無效,總有效率30%;空白組4例有效,26例無效,總有效率13.3%。結(jié)論:本次研究結(jié)果顯示:(1)翰怡灸有溫經(jīng)散寒、活血化瘀之效,用以治療寒凝血型原發(fā)性痛經(jīng)能有效改善痛經(jīng)的疼痛程度。(2)翰怡灸有效調(diào)理月經(jīng)周期經(jīng)量血塊等中醫(yī)癥候。(3)翰怡灸能溫通經(jīng)絡(luò)從而促使經(jīng)絡(luò)暢通。綜合上述三點,本研究發(fā)現(xiàn)翰怡灸對原發(fā)性痛經(jīng)之寒凝血瘀癥的主要癥狀和次癥都有較明顯的緩解作甩并且對一些較嚴(yán)重的痛經(jīng)情況能減輕或根治。翰怡灸有溫經(jīng)散寒、活血化瘀之效,能溫通經(jīng)絡(luò)從而促使經(jīng)絡(luò)暢通。翰怡灸因穴位經(jīng)過熏熨或溫灼,刺激穴位及令藥中的功效發(fā)揮作用,令藥汁的藥效經(jīng)熱力引入各個臟腑經(jīng)絡(luò),并因為是壓炙,令其功效得以持續(xù),這種效果可以維持一至兩天。
[Abstract]:Dysmenorrhea refers to during menstruation or menstruation before and after the abdomen and lumbosacral spasm pain, accompanied by backache, bulge, nausea, vomiting, diarrhea and cold limbs, headache and other symptoms, and with menstruation, serious even fainting, seriously affecting the quality of life of primary dysmenorrhea. Is a common gynecological diseases, called functional dysmenorrhea, 75% primary dysmenorrhea occurred at menarche after first years. The results of the national sample survey in 1980 showed that [1], the incidence of dysmenorrhea was 33.19%, of which the primary dysmenorrhea accounted for 36.06%, which accounted for 44.6% of mild pain, accounted for 38.81%, seriously affecting work the severe 14%. Han Yi is a kind of moxibustion moxibustion, moxibustion and moxibustion between pressure. Yinhan Yi moxibustion moxa moxibustion effect, part of the small and precise temperature compensation of the force into direct acupoints, meridians and organs, the higher efficacy than the other therapy. Through rapid thermal stimulation, wheat As the grain moxibustion is a rapid introduction of various drugs caused by meridian viscera. Objective: This clinical study using John Yi moxibustion in the treatment of cold coagulation and blood stasis type primary dysmenorrhea and its clinical observation, evaluate the clinical efficacy and to explore its mechanism. Methods: from January 2015 to February 2017 were selected from students of Guangzhou University of Chinese Medicine; diagnosis for patients with cold stasis type primary dysmenorrhea in 90 cases, 30 cases randomly divided into experimental group and control group of 30 cases and 30 cases of blank control group. Three groups of patients in the period of one week after treatment. 30 patients in the test group in the treatment of three menstrual cycles by John Yi moxibustion treatment supplies by Dr. Zhang Chaohan. The treatment time: treatment 2-3 times a week, can be treated in dysmenorrhea pain, 3 consecutive courses, to observe the curative effect after 3 courses of treatment. 30 patients in the control group using Nuangongtie treatment of three menstrual cycle treatment. The time of therapy: use 2-3 times a week, dysmenorrhea pain can be used Nuangongtie, 3 consecutive courses, to observe the curative effect after 3 courses of treatment. 30 cases in the control group did not receive any treatment. The observation time: 3 menstrual cycles. The degree of pain scores before and after treatment were observed, dysmenorrhea score and TCM syndrome score. Results: 1. pain score comparison: three groups of 1.1 third months of treatment pain scores, P0.001, the difference was statistically significant, and the treatment group scores less than the control group and the blank group, the control group over the control group of.1.2 score of less than one month after the course the degree of pain score, P0.001, and the difference was statistically significant. The treatment group scores less than the control group and the blank group, the control group is equal to the integral control group.1.3 treatment group and control group before treatment and third months of pain scores, P0.05, the difference was statistically significant, and the integral Less than before treatment.1.4 treatment group and compared the degree of pain over a month integral group third months after treatment and control group, treatment differences of scores of P0.001, the difference was statistically significant after treatment, showed a score of less than third months of treatment,.1.5 treatment group and control group before treatment and third months of treatment the degree of pain P0.001 score difference, the difference was statistically significant, and the difference is greater than the treatment group compared with the control group.2. pain scores: 2.1 three third months treatment dysmenorrhea scores, P0.001, the difference was statistically significant, and the treatment group scores less than the control group and the blank group, the control group score of less than the end of the blank group.2.2 one month after treatment of dysmenorrhea score, p0.001, the difference was statistically significant, and the treatment group scores less than the control group and the blank group, the control group is equal to the integral of the.2.3 treatment group and blank group The control group before treatment and third months, dysmenorrhea score P0.001, the difference was statistically significant, showed the score of less than before treatment,.2.4 treatment group and the comparison of one month dysmenorrhea integral end group third months of treatment and after treatment group, treatment group and control group treated product difference, P0.001, the difference was statistically significant and, showing over the course of treatment was one month after the dysmenorrhea score of less than third months of treatment, the control group after treatment one month dysmenorrhea score greater than third months of treatment,.2.5 treatment group and control group before treatment and third months dysmenorrhea integral difference, P0.001, the difference was statistically significant, and the integral the difference is greater than the treatment group compared with the control group.3. TCM symptom score: comparison of three groups of 3.1, third months of treatment of TCM symptom score of P0.001, the difference was statistically significant, and the treatment group showed small points In the control group and the blank group, the control group over the control group of.3.2 score of less than one month after the course of TCM symptom score, P0.001, the difference was statistically significant, and the display of integral treatment group is less than the control group and the blank group, the control group scores less than the blank group.3.3 treatment group and control group before treatment and third months of traditional Chinese medicine symptom scores were compared, there was statistical significance in treatment group before treatment and third months of treatment of TCM symptom score difference (P0.05), showed the score of less than.3.4 before treatment in treatment group and compare a month end of TCM symptom score group third months after treatment and control group, treatment of integral difference, P0.05, the difference was statistically significant, show the score of less than third months of treatment,.3.5 treatment group and control group before treatment and third months of TCM symptom score difference comparison, P0.001, the difference was statistically significant, and the difference value for treatment Group than the control group.3.6 treatment group and control group before treatment and third months of treatment of TCM symptom score difference between the two groups by the cold / menstrual abdominal heat corrosion, premenstrual / menstrual abdominal pain, less blood, blood clots, after dark, breast pain, limb temperature and nausea vomiting difference mean difference, P0.05, have statistical significance, and the treatment group than in control group.4 the difference between the three groups to compare the clinical efficacy of clinical efficacy between the three groups. The results showed that there was significant difference in curative effect between the three groups (P0.001), the clinical efficacy of the treatment group was higher than that in the control group and blank control group. The treatment group 12 cases of patients in 13 cases were effective, the total efficiency of 100%; control group 29 cases invalid, 1 cases were effective, the total efficiency of 3.3%; control group 29 cases invalid, 1 cases were effective, the total efficiency of 3.3%.5. between the three groups: pain pain clinical efficacy between the three groups. Results 紺轟笁緇勯棿鐤肩棝鐤楁晥宸紓鏈夌粺璁″鎰忎箟(P0.001),娌葷枟緇勭柤鐥涚枟鏁堟湁鏁堢巼楂樹簬瀵圭収緇勫拰絀虹櫧緇，

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