不同长度艾段温针灸治疗肾虚肝郁型弱精症:随机对照试验

Warming-needle moxibustion with different lengths of moxa stick for asthenospermia with kidney deficiency and liver depression: a randomized controlled trial

目的:探讨不同长度艾段温针灸治疗肾虚肝郁型弱精症的临床疗效。方法:将240例肾虚肝郁型弱精症患者随机分为4 cm组(4 cm艾段温针灸组,60例,脱落3例)、3 cm组(3 cm艾段温针灸组,60例,脱落4例)、2 cm组(2 cm艾段温针灸组,60例,脱落2例)和针刺组(60例,脱落3例)。各组患者均穴取中脘、关元、中极、归来、腰阳关、关元俞等分别进行不同长度艾段温针灸和常规针刺治疗,每日1次,每周治疗5次,4周为一疗程,共治疗2个疗程。比较各组患者治疗前后精液常规、精浆生化指标及性激素水平、中医证候评分。结果:治疗后,4 cm组、3 cm组患者精子密度、精子活率、a级精子比例、a+b级精子比例、精浆果糖及中性α-葡萄糖苷酶含量均较治疗前升高(P<0.05,P<0.01),精子畸形率较治疗前降低(P<0.01,P<0.05);4 cm组患者a级精子比例、a+b级精子比例、精浆果糖及中性α-葡萄糖苷酶含量高于其他3组(P<0.05,P<0.01),精子畸形率低于其他3组(P<0.05)。治疗后,除头昏耳鸣评分外,4 cm组、3 cm组患者各项中医证候评分及总分均较治疗前降低(P<0.01,P<0.05);4 cm组患者情绪低落、腰膝酸软、性功能低下评分及总分均低于其他3组(P<0.05,P<0.01)。4 cm组总有效率为87.7%(50/57),高于3 cm组、2 cm组、针刺组的78.6%(44/56)、77.6%(45/58)、70.2%(40/57,P<0.05,P<0.01)。结论:4 cm艾段温针灸可有效提升肾虚肝郁型弱精症患者精子质量和活力,改善临床症状,疗效优于3 cm、2 cm艾段温针灸和常规针刺治疗。

Objective To explore the clinical effect of warming-needle moxibustion with different lengths of moxa stick for asthenospermia with kidney deficiency and liver depression. Methods A total of 240 patients with asthenospermia of kidney deficiency and liver depression were randomly divided into a 4-cm group(moxibustion with 4-cm moxa stick, 60 cases, 3 cases dropped off), a 3-cm group(moxibustion with 3-cm moxa stick, 60 cases, 4 cases dropped off), a 2-cm group(moxibustion with 2-cm moxa stick, 60 cases, 2 cases dropped off) and an acupuncture group(60 cases, 3 cases dropped off). All patients were treated with warming-needle moxibustion with different lengths of moxa stick or conventicnal acupuncture at Zhongwan(CV 12), Guanyuan(CV 4), Zhongji(CV 3), Guilai(ST 29), Yaoyangguan(GV 3), Guanyuanshu(BL 26), etc., once a day, five times a week;4-week treatment was taken as one course, a total of two courses of treatment were given. The semen routine indexes, seminal plasma biochemical indexes, sex hormone levels and TCM syndrome score were compared before and after treatment among the 4 groups. Results After treatment, the sperm density, sperm viability, ratio of grade A sperm, ratio of grade A and B sperm, seminal plasma fructose and neutral α-glucosidase were higher than those before treatment(P<0.05, P<0.01), and the sperm deformity rates were lower than those before treatment in the 4-cm group and the 3-cm group(P<0.01, P<0.05). The ratio of grade A sperm, ratio of grade A and B sperm, seminal plasma fructose and neutral α-glucosidase in the 4-cm group were higher than the other three groups(P<0.05, P<0.01), and the sperm deformity rate was lower than the other three groups(P<0.05). After treatment, except for dizziness and tinnitus score, each-domain score and total scores of TCM syndrome scale in the 4-cm group and the 3-cm group were lower than those before treatment(P<0.01, P<0.05). The each-domain score of depression, weak waist and knees, low sexual function and total score in the 4-cm group were lower than those in the other three groups(P<0.05, P<0.01). The total effective rate was 87.7%(50/57) in the 4-cm group, which was higher than 78.6%(44/56) in the 3-cm group, 77.6%(45/58) in the 2-cm group and 70.2%(40/57) in the acupuncture group(P<0.05,P<0.01). Conclusion The warming-needle moxibustion with 4-cm moxa stick could effectively improve quality and motility of sperm and clinical symptoms in patients with asthenospermia of kidney deficiency and liver depression, which is superior to moxibustion with 3-cm, 2-cm moxa sticks and conventional acupuncture.