热敏灸治疗妇科疾病的应用规律研究

Study on the Application Law of Heat Sensitive Moxibustion in the Treatment of Gynecological Diseases

热敏灸在妇科临床中的适应病症广泛,多用于治疗月经病、带下病、妊娠病、产后病、妇科杂病,证型以寒、湿、瘀和虚证为主,腧穴热敏化通过“辨敏施灸、个体化消敏灸量”的治疗原则以达到“小刺激、大反应”的效果,且均取得显著的临床疗效。就妇科疾病热敏腧穴的分布规律来看,小腹部、腰骶部、下肢部等是热敏化腧穴的高发区,多出现于相关病变脏器的体表投影区(子宫及附件、膀胱等脏器)及相关经络,其中,关元、中极、腰阳关、次髎、肾俞、三阴交、阴陵泉、子宫等穴区的出现频率较高,且95%的热敏腧穴都会发生循经感传,主要集中于任脉、督脉、脾经、肾经、膀胱经。目前,本研究存在以下问题:(1)文献质量总体偏低,缺乏高质量多中心随机对照试验,没有形成系统、规范的诊疗方案和标准;(2)多数临床观察实验没有对热敏现象及其客观指标进行描述;(3)部分文献的治疗选穴为治疗妇科疾病的经验选穴,并没有完全按照热敏灸的探查标准进行选穴,对于非腧穴的热敏化现象缺乏记录和统计;(4)热敏灸感、灸量的探查和判定依靠医者观察及患者自我感知,容易受主观因素的影响,缺乏客观指标的判断标准;(5)热敏灸在妇科病的应用多以病程缓慢的病症为主,对急性病、急性疼痛的研究相对较少;(6)热敏灸治疗妇科疾病的临床疗效观察居多,对于热敏灸的效应靶点、作用机制等基础研究的探索相对不足。今后,应扩大病种研究范围,进行系统化、客观化、规范化的深入研究,充分发挥热敏灸在治疗妇科疾病的潜在价值,以进一步指导临床。

Heat sensitive moxibustion has a wide range of indications in gynecological clinical practice.It is mostly used to treat menstrual diseases,vaginal diseases,pregnancy diseases,postpartum diseases and other gynecological miscellaneous diseases.The syndrome types are mainly cold,dampness,blood stasis and deficiency syndrome.Acupoint heat sensitization achieves the effect of"small stimulation and large reaction"through the treatment principle of"differentation sensitive moxibustion and individualized desensitization moxibustion amount"in order to achieve remarkable clinical efficacy.In terms of the distribution law of thermosensitive acupoints for gynecological diseases,the small abdomen,lumbosacral and lower limbs,etc are the high incidence areas of thermosensitive acupoints,which mostly appear in the body surface projection area of relevant diseased organs(including uterus,accessories,bladder and other organs)and relevant meridians.Among them,Guanyuan(BL 26),Zhongji(RN 3),Yaoyangguan(DU 3),Ciliao(BL 32),Shenshu(BL 23),Sanyinjiao(SP 6),Yinlingquan(SP 9),Zigong(EX-CA1)and other acupoints have a high frequency,and 95%of thermosensitive acupoints have meridian transmission,It mainly focuses on CV,GV,the spleen meridian,the kidney meridian and the bladder meridian.At present,there are the following problems in this study:(1)The overall quality of literature is low,and there is a lack of high-quality multi-center randomized controlled trials,and there is no systematic and standardized diagnosis and treatment plan and standard.(2)Most clinical observation experiments have not described the phenomenon of heat sensitivity and its objective indexes.(3)Some of the treatment points in the literature are selected by experience in the treatment of gynecological diseases,which are not selected according to the exploration standard of heat sensitive moxibustion,and there is a lack of records and statistics on the heat sensitization of non-acupoints.(4)The detection and determination of heat sensitive moxibustion sensation and moxibustion quantity depend on the observation of doctors and the self perception of patients,which is easily affected by subjective factors and lacks the judgment standard of objective indicators;(5)The application of heat sensitive moxibustion in gynecological diseases is mainly the disease with slow course,and the research on acute diseases and acute pain is relatively few.(6)The clinical efficacy of heat sensitive moxibustion in the treatment of gynecological diseases is mostly observed,and the exploration of basic research on the effect target and mechanism of heat sensitive moxibustion is relatively insufficient.In the future,it is necessary to expand the research scope of diseases,carry out systematic,objective and standardized in-depth research,and give full play to the value and potential of heat sensitive moxibustion in the treatment of gynecological and other diseases,to further guide chinical practice.