【作者】 柏琳娜；

【导师】 杨运宽； 梁繁荣；

【作者基本信息】 成都中医药大学 ， 针灸推拿学， 2013， 博士

【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。更多还原

【Abstract】 ObjectiveMethods of literature research, Clinical investigation, expert consultation and demonstration were applied in my dissertation to find all the studies about moxibustion treatment for primary dysmenorrhea. Meanwhile, standardized clinical study, evidenced data and easily promoted treatments, were all designed scientifically in my dissertation, which provide the highly qualified evidence to the clinical application of moxibustion treatment for primary dysmenorrhea with non-drug therapy of traditional Chinese medicine.Methods1. Data mining technology comprehensive system were applied to collect the ancient and modern, Chinese and foreign Monographs and journal literature in treating primary dysmenorrheal by moxibustion. The last treating prescription were set up according to clinical research, expert advice, demonstration and other methods in choosing moxibustion acupuncture point.2. This study is a randomized controlled trial (RCT).152cases were randomly divided into group A (moxibustion group) and group B (fenbid group) treated patients.19cases were lost or dispelled from the study during the treatment. There were69patients in Group A administrated moxibustion treatment. And64patients in group B administrated fenbid. The treatment cycle was3months. Curative effect evaluation standard were as follows:(1) within the group and between groups of VAS scores before and after treatment scores change;(2) into the group of0days RSS retrospective rating scale with three menstrual symptoms after treatment of COX, the dysmenorrhea symptom rating scale change related standards of evaluation.(3) the numerical variation before and after examination on PGF2,and OT in both groups were observed.Results 1. Literature Review:(1)Ancient Literature Review:the first three mainly used acupoints treatment are GuanYuan, ZhongJi, SanYinJiao. Ren Meridian and Foot shaoyin meridian are the acupoints chosen frequency meridians.(2)Contemporary literature review:the first most commonly used way is moxa cone moxibustion then is the moxa stick moxibustion. The first three commonly used acupoints are GuanYuan, ShenQue, SanYinJiao. Acupoints chosen frequency meridians are Ren Meridian and foot Taiyang meridian. The main acupoints chosen in contemporary literature are GuanYuan, ShenQue, and ZhongJi. The main acupoint are mostly on Ren meridian. Moxibustion is applied to the sufficiency syndrome. The study mostly focuses on the cold and dampness sluggish type and Qi stagnation and blood stasis type in the sufficient syndrome. The moxibustion treatment steps in7days before the menstruation according to the literature review. Moxibustion treatment lasts until the arrival of the menstruation. The course of treatment last for7days. The treatment cycle was3months.2.Clinic Study Results:①Set of VAS scores before and after treatment results:the VAS scores analysis in two groups before and after treatment shows statistical significance (P<0.01).②The COX dysmenorrhea symptom score comparison before and after treatment in two groups:A:Dysmenorrhea symptom onset cumulative time results:P values is less than0.01in group A during all assessments; the ratio in first and the second treatment is less than0.05in group B.Later, it is less than0.01.B:Symptom severity situation results:after three courses of treatment in moxibustion group, comparing with the baseline, syndromes of nausea, vomiting, loss of appetite, back pain, leg pain, fatigue, dizziness, diarrhea, insomnia, irritability, complexion change are all released(P<0.01); Headaches, depression, neuroticism reduces (P<0.05). After three courses of treatment, comparing with the baseline period in Western medicine group, syndromes of loss of appetite, skeletons, back pain, fatigue, diarrhea, complexion change, insomnia and whole body pain are released (P<0.01); Nausea, vomiting, headache, leg pain, stomach pain and irritability is lessening (P<0.05).③Two groups of VAS score comparison results:scores of the two groups at baseline and after the third treatment comparison shows that P is more than0.05. Comparison between the first and second treatment, in Western medicine group, it shows that P<0.01.④The COX dysmenorrhea symptom score comparison between two groups:from attacking time and severity, the moxibustion group is better than western medical group in loss of appetite and neurotic (P<0.01). So is in reducing the onset and severity of diarrhea and depression (P<0.05).⑤For the two groups of subjects, PGF2a and OT before and after treatment have a statistically significant difference with P<0.01within the group, while there were no significant differences between groups.⑥Comparison of VAS and cox index after follow-up and three menstrual cycles in the moxibustion group shows P>0.05, while the VAS and COX of abdominal pain in the western medicine group shows statistically significant,which means that the effects rebound. The VAS comparison between two groups has no significant difference. The moxibustion group is better than western medical group in loss of appetite and neurotic (P<0.01). So is in diarrhea, depression, and irritability (P<0.05).Conclusion1. The literature results show that the first three commonly used acupoints to treat primary dysmenorrhea are GuanYuan, ShenQue, SanYinJiao.The cold-damp stagnated type and gas and blood blocking type are the most often used for moxibustion treatment. The moxibustion treatment steps in7days before the menstruation is assertained.2.Between the two group shows are statistically significant. Dysmenorrhea accompanied symptoms in two groups differently improved after every treatment. The scores of PGF2。and OT after treatment were effectively lower than those before treatment within the group.3.After the first and second treatment, comparing with the western medicine, moxibustion group has a slowly long analgesia effect, which play an obvious advantage. After three continuous treatment during three menstrual cycles, the analgesic action of moxibustion can achieve the same analgesic affect as the western medicine group.And moxibustion is better than western medicine group in reducing loss of appetite, neurotic, diarrhea, and the onset of depression. What comes to the comparison among the two groups in the reduction of PGF2。and OT, there are no significant difference.4.Follow-up period:the sustaining curative effect of moxibustion group in the first menstrual cycle is slightly better than western medicine group, which shows that moxibustion has a sustaineing and stable curative effects than western medicine group.更多还原