基于脾经腧穴阳性反应取穴针刺治疗原发性痛经:随机对照研究

Acupuncture Treatment of Primary Dysmenorrhea by Needling Acupoints of the Spleen Meridian with Positive Reactions:A Randomized Controlled Clinical Trial

目的:观察针刺脾经腧穴阳性反应点治疗原发性痛经是否具有优效性,验证临床诊疗中经络腧穴诊查的重要性。方法:将72例原发性痛经患者随机分为腧穴阳性反应点针刺组(观察组)和腧穴标准定位点针刺组(对照组),每组36例。观察组以患者脾经三阴交、地机、阴陵泉穴处或其周围的压痛最敏感点作为针刺点,对照组以此三穴的国家标准定位(GB/T 12346-2006)作为针刺点,于痛经第1、2、3天疼痛发作时连续治疗3d,连续治疗3个月经周期。观察治疗前后视觉模拟量尺(VAS)评分、COX痛经症状量表(CMSS)。结果:两组在即刻缓解疼痛及改善CMSS严重程度方面均疗效显著(P<0.05);观察组在第2、3个月经周期痛经第1天,即刻止痛效果优于对照组(P<0.05);两组在即刻缓解CMSS严重程度方面差异无统计学意义(P>0.05)。结论:针刺三阴交、地机、阴陵泉周围阳性反应点与针刺三穴的标准定位点均有即刻缓解疼痛的作用,针刺阳性反应点的即刻止痛效果更显著,初步提示依据经络腧穴诊察取得阳性反应点进行针刺,可以提高止痛效果。

Objective To observe whether acupuncture of the tender-points of the Spleen Meridian can achieve a better therapeutic effect for primary dysmenorrhea（PD）patients,so as to verify the importance of examining meridian-acupoint reactions in clinical practice.Methods A total of 72PD patients were randomly assigned to tender-point group（observation group）and regular acupoint group（control group,n=36in each）.For patients of the observation group,the tender-points around Sanyinjiao（SP 6）,Diji（SP 8）and Yinlingquan（SP 9）were needled,and for those of the control group,the regular SP 6,SP 8and SP 9were needled.After＂Deqi＂,the filiform needles were manipulated with lifting-thrusting reducing technique for about 30s,repeated once again every 10min during 30min’s needle retention,and the treatment was conducted once daily for 3days during every menstrual cycle,continuously for 3months.The visual analogue scale（VAS）was rated for assessing the pain severity,and the COX menstrual symptom scale（CMSS）consists of 17items and 5grades/item（0-4points）according to the severity of discomfort was rated before and after the treatment.Results After the treatment,the VAS and CMSS scores on the 1^st days of the 1^st,2^nd and 3^rd menstrual cycles were significantly decreased in both control and observation groups in comparison with their own individual pre-acupuncture（P〈0.05）,suggesting a marked relief of both pain and discomforts after the treatment,and the therapeutic effect of the tender-point needling was significantly superior to that of the regular acupoint needling in relieving pain in the 2^nd and 3^rd menstrual cycles.No significant difference was found between the two groups in the discomfort severity（P〉0.05）.Conclusion Acupuncture stimulation of the tender points around the SP 6,SP 8and SP 9has a stronger analgesic effect relevant to needling the regular acupoints in PD patients.