膈下逐瘀汤加味联合揿针穴位埋针治疗气滞血瘀型原发性痛经临床观察

Clinical observation on treating primary dysmenorrhea of Qi stagnation and blood stasis type by the Gexia Zhuyu decoction plus the acupoint embedding thumb-tag needle therapy

目的:评估膈下逐瘀汤联合揿针穴位埋针疗法治疗原发性痛经(Primary Dysmenorrhea,PD)的临床疗效,探究其作用机制。方法:收集2018年1月-2020年10月就诊于韶关市中医院妇科门诊的气滞血瘀型PD患者120例,采用随机数字表法将其分为治疗组、对照组A、对照组B、对照组C,每组30例。治疗组采用膈下逐瘀汤加味联合揿针穴位埋针治疗,对照组A组口服双氯芬酸钠肠溶片治疗;对照组B采用单纯中药口服法(药物组成同治疗组),对照组C采用单纯揿针穴位埋针(取穴同治疗组)。四组均连续治疗3个月经周期。结果:治疗后,治疗组临床总有效率、前列腺素E2(Prostaglandin E2,PGE2)水平高于对照组A、对照组B、对照组C;视觉模拟评分(Visual Analogue Scale,VAS)、中医证候积分、COX痛经症状量表(COX Menstrual Symptom Scale,CMSS)、前列腺素F2α(Prostaglandin F2α,PGF2α)水平低于对照组A、对照组B、对照组C;差异有统计学意义(P<0.05)。治疗后,治疗组阻力指数(Resistance Index,RI)与搏动指数(Pulsation Index,PI)均低于对照组A、对照组B、对照组C,差异有统计学意义(P<0.05)。四组患者治疗期间均未见明显不良反应。结论:膈下逐瘀汤加味中药口服联合揿针穴位埋针治疗PD患者效果确切,可缓解患者临床症状。其机制可能与提高PGE2水平,降低PGF2α水平有关。此疗法同时还可改善患者子宫动脉血流情况,缓解疼痛感,值得推广应用。

Objective:To evaluate the clinical effect of the Gexia Zhuyu decoction(膈下逐瘀汤)combined with the acupoint embedding thumb-tag needle therapy on primary dysmenorrhea(PD),and to explore its mechanism.Methods:From January 2018 to October 2020,a total of 120 PD patients with Qi(气)stagnation and blood stasis who met the inclusion criteria of this study were collected and divided into the treatment group,the control group A,the control group B,and the control group C by random number table method,with 30 cases in each group.The treatment group was treated with the Gexia Zhuyu decoction combined with the acupoint embedding thumb-tag needle therapy.The control group A oral diclofenac sodium enteric-coated tablet treatment,the control group B was treated with simple oral TCM medicine(drug composition was the same as the treatment group),in the control group C,a simple press needle was used to bury the needle at the point(the same point selection as the treatment group).All the four groups were treated for 3 consecutive menstrual cycles.Results:After treatment,the total effective rate,the level of prostaglandin E2(PGE2)in the treatment group were higher than those in the control group A,B and C.And the visual analogue scale(VAS),TCM syndrome score,O Clinical Journal of Chinese Medicine 2023-78-Vol.(15)No.16 COX menstrual symptom scale(CMSS),and the level of prostaglandin F2α(PGF2α)in the treatment group were lower than those in the control group A,B and C(P<0.05).After treatment,the RI and PI in the treatment group were lower than those in the control group A,B and C(P<0.05).There were no obvious adverse reactions in the four groups during treatment.Conclusion:The Gexia Zhuyu decoction combined with the acupoint embedding thumb-tag needle therapy has a definite effect in the treatment of PD patients,which can relieve the clinical symptoms of patients,and its mechanism may be related to the increase of PGE2 level and the decrease of PGF2αlevel.At the same time,it can improve the blood flow of uterine artery and relieve pain,which is worthy of promotion and application.