大灸量温针灸治疗原发性早泄肾虚肝郁证:随机对照试验

Primary premature ejaculation of kidney deficiency and liver stagnation treated with warm acupuncture of large-quantity moxibustion:a randomized controlled trial

目的:观察大灸量温针灸治疗原发性早泄肾虚肝郁证的临床疗效。方法:将240例原发性早泄肾虚肝郁证患者随机分为温针组(80例,脱落5例)、针刺组(80例,脱落4例)、西药组(80例,脱落6例)。温针组予大灸量温针灸治疗,穴取百会、气海、关元、中极及双侧风池、额旁3线、内生殖器(耳穴)、肝俞、肾俞等。每次40 min,每日1次,每周5次,共治疗4周。针刺组不进行艾灸,针刺操作与温针组一致。西药组予盐酸达泊西汀片口服,每次30 mg,性交前1~3 h温水送服,24 h内最多服药1次,每周最多使用2次,4周内完成6次使用。观察各组患者治疗前后中医证候评分、早泄诊断工具量表(PEDT)评分、阴道内射精潜伏时间(IELT)、血清性激素含量[睾酮(T)、黄体生成素(LH)、卵泡刺激素(FSH)],并评定临床疗效。结果:治疗后,各组患者性交不足1 min、泄后疲惫、精神低落、性欲减退评分及总分,PEDT评分均较治疗前降低(P<0.01,P<0.05),IELT均较治疗前延长(P<0.01);温针组血清T含量较治疗前升高(P<0.05)。治疗后,温针组泄后疲惫、腰膝酸软、性欲减退、少寐多梦、夜尿频评分及总分低于针刺组和西药组(P<0.05,P<0.01),血清T含量高于针刺组和西药组(P<0.05);温针组与西药组PEDT评分低于针刺组、IELT长于针刺组(P<0.05,P<0.01)。温针组总有效率为82.7%(62/75),高于针刺组的68.4%(52/76)和西药组的64.9%(48/74,P<0.05)。结论:大灸量温针灸能改善原发性早泄肾虚肝郁证患者的临床症状,延长阴道内射精潜伏时间,改善性激素水平。

Objective To explore the clinical effect of warm acupuncture with large-quantity moxibustion on primary premature ejaculation(kidney deficiency and liver stagnation).Methods A total of 240 patients with primary premature ejaculation(kidney deficiency and liver stagnation)were randomly divided into a warm acupuncture group(80 cases,5 cases dropped out),an acupuncture group(80 cases,4 cases dropped out)and a western medication group(80 cases,6 cases dropped out).In the warm acupuncture group,a large quantity of moxibustion was delivered after acupuncture at Baihui(GV 20),Qihai(CV 6),Guanyuan(CV 4)and Zhongji(CV 3),as well as bilateral Fengchi(GB 20),lateral line 3 of forehead(MS 4),neishengzhiqi(TF 2),Ganshu(BL 18),Shenshu(BL 23),and etc.One treatment with warm acupuncture took 40 min,once daily;five treatments were given per week and 4 weeks of treatment was required.In the acupuncture group,moxibustion was not delivered,and the rest operation of acupuncture was same as the warm acupuncture group.In the western medication group,dapoxetine hydrochloride tablets were administered orally,30 mg each time,taken with warm water 1 h to 3 h before sexual intercourse.Medication was administered at most once within 24 h,twice per week,and 6 times within 4 weeks.Before and after treatment,the score of TCM symptoms,the score of premature ejaculation diagnostic tool(PEDT),intravaginal ejaculation latency time(IELT)and the serum sex hormone content(testosterone[T],luteinizing hormone[LH]and follicule stimulating hormone[FSH])were observed and the clinical effect was evaluated in the three groups.Results After treatment,the scores for less duration of intercourse(<1 min),post-ejaculation fatigue,low spirit and decreased libido,and the total scores of TCM symptoms,as well as PEDT scores were reduced when compared with those before treatment in each group(P<0.01,P<0.05),and IELT was prolonged(P<0.01)in the three groups.The serum T content was increased when compared with that before treatment in the warm acupuncture group(P<0.05).After treatment,in comparison with the acupuncture group and the western medication group,the scores for post-ejaculation fatigue,soreness and weakness in the lumbar region and knee joints,decreased libido,insomnia,dream-disturbed sleep and frequent nocturnal enuresis,as well as the total score of TCM symptoms were lower(P<0.05,P<0.01)and the serum T content was increased(P<0.05)in the warm acupuncture group.When compared with the acupuncture group,PEDT scores were lower and IELT prolonged in the warm acupuncture group and the western medication group(P<0.05,P<0.01).The total effective rate was 82.7%(62/75)in the warm acupuncture group,higher than that of the acupuncture group(68.4%,52/76)and the western medication group(64.9%,48/74,P<0.05)respectively.Conclusion Warm acupuncture with large-quantity moxibustion ameliorates the clinical symptoms and increases intravaginal ejaculation latency time and the levels of sex hormone in the patients with primary premature ejaculation(kidney deficiency and liver stagnation).