论《伤寒论》之“痞”(上)

在张仲景的书中"痞""痞硬(硬满)""结胸"三症状是不同的,仲景定义"痞"为"不痛",典型的方证如第154条、第164条的小泻心汤方;"结胸"定义为"按之痛",典型方证如第135条、第137条的大陷胸汤证;而在临床中还有很多时候,患者症状介于"痞"和"结胸"之间,有疼痛但是比较轻微,既不属于完全不痛的"心下痞、气痞",又不属于疼痛明显的"结胸",张仲景将其称为"痞硬"或"硬满",两者意义相同,方证如第96条、第230条、第266条的柴胡汤证,第157条、第158条的生姜泻心汤证和甘草泻心汤证,第160条的旋复代赭汤证,第163条的桂枝人参汤证,第165条的大柴胡汤证,第166条的瓜蒂散证,第124条的抵当汤证。从仲景的行文可以看出三者关系为:痞→痞硬(硬满)→痞硬痛(结胸),由"但满不痛"到"痛不可近"是一个由轻到重的过程。由此推断半夏泻心汤当有疼痛。

拨法的应用与研究

拨法是指"以痛为腧,不痛用力"的手法,能消除炎症,解除痉挛。以疏通经络为目的,化"不通"为"通",使局限性痛变"痛"为"不痛"。主要适用于因损伤而致紧张、痉挛为主的痛,"不痛用力"的拨法是在"以痛为腧"痛的基础上进行的。

Transdermal Fentanyl for Management of Cancer Pain in Elderly Patients in China

Objective: Objective: To assess the effect and adverse effects of transdermal fentanyl for elderly patients with cancer pain in China. Methods: A total of 1664 elderly patients (aged 65-90 with mean age of 72.6) with cancer pain enrolled in the multicenter study from 136 institutes in China. Of them, 408 (28.8%) patients were 75 years old or older. All patients received transdermal fentanyl for the management of cancer pain. The patients were asked to record the attacks of pain, quality of life, and any side effects of the treatment. Results: Baseline mean of pain intensity was 7.34. On day 1, 3, 6, 9 15, and 30, the pain mean scores were decreased to 3.82, 2.80, 2.43, 2.11, 1.83, 1.64 (P=0.000). The effective rate was 97.18%. The mean doses of fentanyl was 31.34 g/h (25-150 g/h) initially, and 40.59 g/h and 47.50 g/h (25-200 g/h) at day 15 and day 30. At treatment day 15, the dose of fentanyl was ranger from 25 to 50 g/h in 91.8% of patients, 75 to 100 g/h in 7.5% patients, and 125 to 200 g/h only in 0.8% patients. The fine quality of life was in 25.4% patients before treatment, and was 71.15% and 73.04% at day 15 and day 30 respectively (P=0.0000). The common side effects were constipation (10.70%), nausea (11.96%), dizzy (6.85%), vomiting (3.85%), sedation (2.40%), Respiratory depression (0.12%). 86.2% patients preferred continue treated by transdermal fentanyl. Conclusions: Transdermal fentanyl for the elderly with cancer pain is effective, safe, convenient, and can improve the quality of life. Transdermal fentanyl can be recommended as a first-line drug for the treatment of elderly patients with moderate to severe cancer pain, and the initial doses is recommended as 25 g/h.

Characterization of functional biliary pain and dyspeptic symptoms in patients with sphincter of Oddi dysfunction:Effect of papillotomy

AIM： To characterize functional biliary pain and other gastrointestinal （GI） symptoms in postcholecystectomy syndrome （PCS） patients with and without sphincter of Oddi dysfunction （SOD） proved by endoscopic sphincter of Oddi manometry （ESOM）, and to assess the postendoscopic sphincterotomy （EST） outcome. METHODS： We prospectively investigated 85 cholecystectomized patients referred for ERCP because of PCS and suspected SOD. On admission, all patients completed our questionnaire. Physical examination, laboratory tests, abdominal ultrasound, quantitative hepatobiliary scintigraphy （QHBS）, and ERCP were performed in all patients. Based on clinical and ERCP findings 15 patients had unexpected bile duct stone disease and 15 patients had SOD biliary type Ⅰ. ESOM demonstrated an elevated basal pressure in 25 patients with SOD biliary-type Ⅲ. In the remaining 30 cholecystectomized patients without SOD, the liver function tests, ERCP, QHBS and ESOM were all normal. As a control group, 30 ‘asymptomatic＇ cholecystectomized volunteers （attended to our hospital for general cardiovascular screening） completed our questionnaire, which is consisted of 50 separate questions on GI symptoms and abdominal pain characteristics. Severity of the abdominal pain （frequency and intensity） was assessed with a visual analogue scale （VAS）. In 40 of 80 patients having definite SOD （i.e. patients with SOD biliary type Ⅰ and those with elevated SO basal pressure on ESOM）, an EST was performed just afl：er ERCP. In these patients repeated questionnaires were filled at each follow-up visit （at 3 and 6 too） and a second look QHBS was performed 3 mo after the EST to assess the functional response to EST. RESULTS： The analysis of characteristics of the abdominal pain demonstrated that patients with common bile duct stone and definite SOD had a significantly higher score of symptomatic agreement with previously determined biliary-like pain features than patient groups of PCS without SOD and controls. In contrary, no significant differences were found when the pain severity scores were compared in different groups of PCS patients. In patients with definite SOD, EST induced a significant acceleration of the transpapillary bile flow; and based on the comparison of VASs obtained from the pre-and post-EST questionnaires, the severity scores of abdominal pain were significantly improved, however, only 15 of 35 （43%） patients became completely pain free. Post-EST severity of abdominal pain by VASs was significantly higher in patients with predominant dyspepsia at initial presentation as compared to those without dyspeptic symptoms. CONCLUSION： Persistent GI symptoms and general patient dissatisfaction is a rather common finding after EST in patients with SOD, and correlated with the presence of predominant dyspeptic symptoms at the initial presentation, but does not depend on the technical and functional success of EST.

Agenesis of the dorsal pancreas

During the last 100 years in medical literature,there are only 54 reports,including the report of Pasaoglu et al(World J Gastroenterol 2008;14:2915-2916),with clinical descriptions of agenesis of the dorsal pancreas in humans.Agenesis of the dorsal pancreas,a rare congenital pancreatic malformation,is associated with some other medical conditions such as hyperglycemia,abdominal pain,pancreatitis and a few other diseases.In approximately 50% of reported patients with this congenital malformation,hyperglycemia was demonstrated.Evaluation of hyperglycemia and diabetes mellitus in all patients with agenesis of the dorsal pancreas including description of fasting blood glucose,oral glucose tolerance test,glycated hemoglobin and medical treatment would be a future goal.Since autosomal dominant transmission has been suggested in single families,more family studies including imaging technologies with demonstration of the pancreatic duct system are needed for evaluation of this disease.With this letter to the editor,we aim to increase available information for the better understanding of this rare disease.

Left atrial area index predicts adverse cardiovascular events in patients with unstable angina pectoris

Background The left atrial size has been considered as a useful marker of adverse cardiovascular outcomes. However, it is not well known whether left atrial area index （LAAI） has predictive value for prognosis in patients with unstable angina pectoris （UAP）. This study was aimed to assess the association between LAAI and outcomes in UAP patients. Methods We enrolled a total of 391 in-hospital patients diag- nosed as UAP. Clinical and echocardiographic data at baseline were collected. The patients were followed for the development of ad- verse cardiovascular （CV） events, including hospital readmission for angina pectoris, acute myocardial infarction （AMI）, congestive heart failure （CHF）, stroke and all-cause mortality. Results During a mean follow-up time of 26.3±8.6 months, 98 adverse CV events occurred （84 hospital readmission for angina pectoris, four AMI, four CHF, one stroke and five all-cause mortality）. In a multivariate Cox model, LAAI [OR： 1.140, 95% CI： 1.01±1.279, P = 0.026], diastolic blood pressure （OR： 0.976, 95% CI： 0.956-0.996, P = 0.020） and pulse pressure （OR 1.020, 95% CI： 1.007-1.034, P = 0.004） were independent predictors for adverse CV events in UAP patients. Conclusions LAAI is a predictor of adverse CV events independent of clinical and other echocardiographic parameters in UAP patients.

腹针与神阙艾灸治疗痛经、不孕症、闭经

腹针疗法以独创腹部全息影像,以神阙为中心,调节脏腑、经络,扶正祛邪,针刺深度较浅,刺激强度较小,安全性高,患者易接受。在腹部形成一个具有多层次的神阙经络系统。腹针分调脏腑、调经络、调局部,取穴以任脉为主,调脏腑穴位一般深刺,结合八卦理论,调经络穴位中刺,取穴根据病位在全息影像中的投射区而定,常用于治疗久病、慢性病、妇科杂病。腹针疗法具有“处方标准化、操作规范化、辨证条理化”等特点,既具有传统针灸的特色,又有自身的诊治优势,痛苦小、见效快、疗效稳定、适应症广等,采用腹针疗法治疗妇科相关疾病,痛经、不孕症、闭经等,患者易于接受,效果显著,值得推广。气滞血瘀痛经,以气海、关元为主,配引气归元、中极等,神阙艾灸,3个疗程可愈。肝郁不孕以引气归元为主,辅以腹四关,配下风湿点、气穴,神阙艾灸,5个疗程后,基本良好,嘱定期产检。气滞血瘀闭经以引气归元为主,辅以腹四关,配大横、气穴、气旁、归来,神阙艾灸,3个疗程后,基本情况明显缓解。

AN UNUSUAL CASE OF ASYMPTOMATIC APLASTIC RENAL DYSPLASIA

The postmortem examination of a 59-year-old man who had suffered from acute abdominal pain for two days revealed that the cause of death was peritonitis secondary to perforated peptic ulceration. During examination,it was found that the urinary tract was abnormal. Here, we report a postmortem finding of aplastic renal dysplasia of the kidney and malformation of the urinary tract.

Effects of adjuvant Chinese patent medicine therapy on major adverse cardiovascular events in patients with coronary heart disease angina pectoris:a population-based retrospective cohort study

Objective: This study aimed to explore the effects of Chinese patent medicine(CPM) in reducing the incidence of major adverse cardiovascular events(MACE) in patients with coronary heart disease(CHD) angina pectoris and improving clinical effectiveness and provide evidence for its use as clinical adjuvant therapy.Methods: Twenty-eight thousand five hundred and seventeen patients hospitalized with CHD angina pectoris from 6 hospitals were divided into CPM group(n = 11,374) and non-CPM group(n = 17,143) to evaluate the incidence of MACE, including myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting.Results: The incidence of MACE in the CPM group was lower than that in the non-CPM group. CPM therapy was an independent protective factor that reduced the overall risk of MACE [adjusted hazard ratio = 0.40, 95% confidence interval(0.33;0.49)]. Patients in the CPM group who received one, two, or three types of CPM could benefit from adjuvant treatment with CPM, and taking more types of CPM was associated with a lower risk of MACE. In addition, the male population was better than the female population at taking CPM, and middle-aged people aged 55 to 64 were more suited to take CPM based on Western medicine.Conclusions: The use of CPM as adjuvant therapy can decrease the occurrence of MACE in patients with CHD angina pectoris,especially in men and middle-aged people, and the drug treatment plan should be optimized accordingly. However, this conclusion needs further verification by prospective cohort studies in the future.

Effects of Xin Mai Tong Capsule on Vasoregulatory Peptides in the Patients of Coronary Heart Disease

In order to inquire into the therapeutic effects of Xin Mai Tong Capsule (心脉通胶囊) on coronary heart disease with myocardial ischemia, 40 patients were randomly divided into two groups (Xin Mai Tong group and the control group). The plasma endothelin (ET) levels in the two groups of patients were markedly higher than that of the healthy people (P<0.001), and the calcitonin gene related peptide (CGRP) was similar to that of the healthy people (P>0.05). After treatment, ET and symptomatic scores in the two groups decreased markedly (P<0.01), and their S-T segments were elevated obviously (P<0.01). But the decrease of ET and symptomatic scores and elevation of S-T segment in Xin Mai Tong group were superior to those of the control group (P<0.05～0.01). The CGRP level in the control group did not vary obviously post-treatment, but it increased markedly (P<0.01) with the addition of Xin Mai Tong Capsule in Xin Mai Tong group.

OUTCOMES OF INVASIVE STRATEGY TO PATIENTS WITH NON-ST-ELEVATION ACUTE CORONARY SYNDROMES

Objective To compare the outcomes of an invasive with a conservative strategy in the manage-ment of patients with non-ST-elevation acute coronary syndromes. Methods From January 2000 to June 2001, 505 patients presenting with unstable angina or non-Q wave myocardial infarction were divided into two groups (conservative vs. invasive) according to management strategy. Patients assigned to an early invasive strategy underwent coronary angiography within 7d of enrollment after intensive antiplatelet, antithrombotic and antiangina therapy and revascularization as appropriate. All patients were followed up at least 6 months. The primary endpoints were cardiac death and acute myocardial infarction. Recurrence angina and readmission were the secondary end-point. Results There were 194 patients in conservative group and311 patients in invasive group. Overall, coronary angiography was performed in 100% and 56% , and revascularization in 93% and 52% in the invasive and conservative groups, respectively. During a mean of 11±5.7 months (range 6 ~ 24 months) of follow-up, the occurrence of primary endpoint was significantly lower in the invasive group than that in the conservative group (3.9% vs 8. 2% , P =0. 036). The rate of recurrent angina (48% vs 17% , P =0. 001) , readmission (41% vs 13% , P = 0. 001) and revascularization (12% vs 35% , P =0. 001) was also significantly lower in patients assigned to invasive strategy. Conclusion The study indicates that the early invasive approach may be the preferred strategy in patients with unstable angina or non-Q wave myocardial infarction.

CLINICAL OBSERVATION ON TREATMENT OF 83 CASES OF POSTHEMIPLEGIC OMALGIA

An analysis on 83 cases of posthemiplegic omalgia (shoulder pain) shows that the pathogenesis of the pain is closely related to the improper passive movement at the early stage of hemiplegia (62.7%). The large range of passive movement is a dangerous factor leading to omalgia. In the study of upper extremity complications, the incidence of shoulder-hand syndrome is relatively high (42.2%), and it is often accompanied by hand swelling (83.1%). The authors suggest that painless movement of the shoulder joint should be limited in a range of 90-120 degrees, massage be carried out immediately after acupuncture, and the affected upper extremity be moved passively during the needle retention. This therapeutic method is definitely effective for pasthemiplegic omalgia.

Concomitant acute myocardial infarction and descending thoracic aorta penetrating ulcer

Acute coronary syndrome （ACS） refers to a spectrum of clinical presentations ranging from unstable angina to non-ST-segment elevation myocardial infarction （NSTEMI） to ST-segment elevation myocardial infarction （STEMI）. Aortic dissection, intramural hematoma and penetrating atherosclerotic ulcer （PAU） are three major acute aortic syndromes （AAS）.

Behavioral assessments of the aversive quality of pain in animals

Animals and humans share similar mechanisms of pain detection and similar brain areas involved in pain processing.Also,they show similar pain behaviors,such as reflexed sensation to nociceptive stimuli.Pain is often described in sensory discrimination （algosity） and affective motivation （unpleasantness） dimensions.Both basic and clinical findings indicate that individuals with chronic pain usually suffer more from pain-associated affective disturbances than from the actual pain sensations per se.Although the neural systems responsible for the sensory component of pain have been studied extensively,the neural mechanisms underlying negative affective component are not well understood.This is partly due to the relative paucity of animal paradigms for reliable examination of each component of pain.In humans,the experience of pain and suffering can be reported by language,while in animals,pain can only be inferred through physical and behavioral reactions.Animal behaviors,cognitive psychology and functional brain imaging have made it possible to assess pain affection and pain memory in animals.Animals subjected to either neuropathic injury or inflammatory insult display significant conditioned place aversion to a pain-paired environment in behaviors.The present review aims to summarize the common methods of affective unpleasantness assessment in rats.

Effect of Acupuncture plus Rehabilitation Training on Shoulder-hand Syndrome Due to Ischemic Stroke

Objective：To observe the clinical effect of acupuncture plus rehabilitation training in treating early-stage shoulder-hand syndrome due to ischemic stroke.Methods：Sixty patients were randomized into an observation group and a control group,30 in each.The observation group was intervened by acupuncture plus rehabilitation training,and the control group only received rehabilitation training.After 3 treatment courses,the scores of visual analogue scale （VAS） and Fugl-Meyer assessment scale （FMA）,and the clinical effect were compared between the two groups.Results：The two groups both obtained significant improvements in VAS and FMA scores after treatment （P〈0.05 or P〈0.01）.After treatment,it showed marked differences in comparing VAS and FMA scores between the observation group and the control group （P〈0.05）.The total effective rate was 86.7% in the observation group,versus 63.3% in the control group,and the difference was statistically significant （P〈0.05）.Conclusion：The result of acupuncture plus rehabilitation training in treating early-stage shoulder-hand syndrome due to ischemic stroke is superior to rehabilitation training alone.

Tuina for Leg Length Discrepancy and Lumbosacral Pain Due to Sacroiliac Joint Subluxation

Objective： To observe theclinical effect of tuina reduction manipulation on leg length discrepancy and lumbosacral pain due to sacroiliac joint subluxation. Methods： A total of 60eligible cases were randomly allocated into an observation group and a control group, 30 in each group. Cases in the observation group were treated with conventional tuina plus reduction manipulation of sacroiliac joint subluxation; whereas cases in the control group were treated with conventional tuina plus acupuncture. The clinical effects were observed after 10 times of treatment. In addition, the relapse rates were observed 2 months after treatment. Results： The total effective rate in the observation group was 80.0%, versus 50.0% in the control group, showing a statistically significant difference （P＆lt;0.05）. The relapse rate of lumbosacral pain in the observation group was 12.5%, versus 66.7% in the control group, showing a statistically significant difference （P＆lt;0.01）. The relapse rate of leg length discrepancy in the observation group was 16.7%, versus 80.0% in the control group, showing a statistically significant difference （P＆lt;0.01）. Conclusion： Tuina reduction manipulation can obtain substantial therapeutic effect for leg length discrepancy and lumbosacral pain due to sacroiliac joint subluxation, coupled with a low relapse rate.

Effect Observation on Point-through-point Needling Combined with Tuina for Post-stroke Shoulder-hand Syndrome

Objective：To observe the effect of point-through-point needling combined with tuina for shoulder-hand syndrome after stroke.Methods：Eighty-six cases with post-stroke shoulder-hand syndrome were randomly divided into an observation group and a control group,43 cases in each group.Patients in the observation group were treated by point-through-point needling combined with tuina therapy on the basis of the conventional treatment;while patients in the control group were treated by tuina therapy on the basis of conventional therapy.Six treatments constitute a course,and the efficacy was evaluated after 4 courses.Results：The total effective rate was 88.4% in the observation group,and it was 69.8% in the control group.And the comparison indicated that the observation group had a more efficient result than the control group did （χ 2 =4.497,P〈0.05）.The scores of visual analogue scale （VAS） and Fugl-Meyer assessment （FMA） were significantly improved after treatments in both groups （P〈0.05 or P〈0.01）.After treatment,the scores of VAS and FMA of the observation group were significantly different from that in the control group （P〈0.05）.Conclusion：Because of the efficacy,point-through-point needling combined with tuina therapy for shoulder-hand syndrome after stroke is certainly worthy of further study,and can be used in clinical practice.

Clinical characteristics of acute ischemic syndrome in China

OBJECTIVE: To analyse the characteristics and therapies of patients with acute ischemic syndrome in China. METHODS: This study is part of the international multicentre registry for acute ischemic syndrome. Since April 1999, the data of patients admitted to designated hospitals with acute ischemic cardiac chest pain were collected by filling in Case Report Forms offered by the Canadian Cardiovascular Collaboration. The main clinica l characteristics and in hospital events of the patients were recorded. RESULTS: Fifteen hundred and nine cases of acute ischemic syndrome from 34 hospitals nationwide were enrolled in the registry (including unstable angina and non Q-wave myocardial infarction).The mean age of the patients was 62.3. Male dominance (62.2%) was noted. The percentages of patients with chest pain at presentation and abnormal ECG were 47.8% and 89.5%, respectively. The most common clinical diagnosis on admission was unstable angina, accounting for 91.3% of the patients and non Q-wave myocardial infarction (MI), accounting for the other 8.7%. During hospitalization, the following interventions were given: thrombolytic therapy in 50 cases (3.3%), coronary angiography in 528 cases (35.0%), percutaneous transluminal coronary angioplasty (PTCA) in 253 cases (16.8%) and coronary artery bypass graft surgery (CABG) in 62 cases (4.1%). Nitrate (oral or patch ) and anti-platelet therapy were used in 1460 cases (96.8%) and 1441 cases (95.5%), respectively. The incidence of in hospital major events was 18.8%, in cluding 18 deaths (1.2%), with the most common causes being severe arrhythmias and sudden death. CONCLUSIONS: Patients with acute ischemic syndrome in China have mostly been diagnosed as cases of unstable angina. A relatively high PTCA rate but low CABG rate was noted in China. The most common cause of in hospital death is severe arrhythmias or sudden death.

Danshenchuanxiongqin injection in the treatment of unstable angina pectoris: a systematic review and Meta-analysis

OBJECTIVE:To evaluate systematically the efficacy and safety of Danshenchuanxiongqin Injection(DCI)in the treatment of unstable angina pectoris(UAP).METHODS:Randomized controlled trials(RCTs)regarding DCI used for treating UAP were searched in English and Chinese electronic databases from inception to January 2014.Two reviewers independently retrieved RCTs and extracted relevant information.The Cochrane risk of bias method was used to assess the quality of included studies,and a Meta-analysis was conducted with Review Manager5.2 software.RESULTS:Eleven RCTs involving 1034 participants were included.The methodological quality was relatively passable.The Meta-analysis indicated that the combined use of DCI and conventional treatment with Western Medicine(WM)was more efficacious in the outcomes of total effective rate[Relative Risk(RR)=1.27,95%CI(confidence interval;1.18,1.35),P<0.000 01],the total effective rate of ECG[RR=1.40,95%CI(1.18,1.66),P<0.000 01],total cholesterol[Mean difference(MD)=-0.58,95%CI(-0.83,-0.33),P<0.000 01],total triglycerides[MD=-0.36,95%CI(-0.54,-0.17),P=0.0001],and the number of ST-segment depression[MD=-0.36,95%CI(-0.54,-0.17),P=0.0001].There were two adverse drug reactions reported in one study.CONCLUSION:Based on the systematic review,DCI combined with WM appeared to be efficacious in the treatment UAP.However,the evidence of DCI for treating UAP requires large-scale and double-blind RCTs to substantiate these findings.

Mild moxibustion at different intervention times on the levels of ET-1 and NO in the uterine tissues of rats with cold-damp coagulation and stagnation type dysmenorrhea

Objective： To observe the differences in analgesic effect of moxibustion at different intervention times on dysmenorrhea rats and explore its effect mechanism.Methods： Forty-five female Wistar rats were randomly divided into blank control group（group A）, model group（group B）, pre-moxibustion group（group C）, instant moxibustion group（group D） and pre-instant moxibustion group（group E）,with 9 rats in each group. Cold-damp coagulation and stagnation type dysmenorrhea models were established. In group C,mild moxibustion on ＂Shenque（神阙 CV 8） ＂ and＂Guanyuan（关元 CV 4）＂ was carried out from the time after modeling on the 8 th day for 3 consecutive days. In group D, mild moxibustion was given as the same methods with group C after injection with oxytocin on the 11 th day. In group E, mild moxibustion was given as the same methods from the time after modeling on the 8 th day to that after injection with oxytocin on the 11 th day for 4 consecutive days. The writhing behavior and the changes in levels of ET-1 and NO in uterine tissues of rats with dysmenorrhea in each group were observed.Results： Comparison of the latent period： compared with（4.38 ± 1.06） min in group B,the latent period of rats in group C（9.67 ± 1.32） min,group D（11.78 ± 1.30） min and group E（15.00 ± 1.22） min obviously prolonged（all p 0.01）. Compared with group C, the latent period of group E obviously prolonged（p 0.01）. Compared with group D, the latent period of group E obviously prolonged（p 0.01）.Comparison of the writhing times： compared with（4.38 ± 1.06） in group B,the writhing times of rats in group C（9.67 ± 1.32）,group D（11.78 ± 1.30） and group E（15.00 ± 1.22） reduced（all p 0.01）. Compared with group C,the writhing times of rats in group D and group E reduced（both p 0.01）. Compared with group D, the writhing times in group E reduced（p 0.05）. Comparison of the total writhing score：compared with（4.38 ± 1.06） in group B,the total writhing score of rats in group C（9.67±1.32）,group D（11.78 ± 1.30） and group E（15.00 ± 1.22） decreased（all p 0.01）. Compared with group C,the total writhing score of rats in group D and group E decreased（both p 0.01）. Compared with group D,the total writhing score of rats in group E decreased（p 0.05）. Comparison of ET-1 level： compared with（4.80 ± 0.47） in group A,the ET-1 level in uterine tissues of rats in group B（7.57±0.69） significantly increased（P 0.01）. Compared with group B, the ET-1 level in uterine tissues of rats in group C（6.20 ±0.50）,group D（5.67 ±0.29） and group E（5.16±0.33） obviously decreased（all p 0.01）. Compared with group C, the ET-1 level in uterine tissues of rats in group D and group E obviously decreased（p 0.05, p 0.01）. Compared with group D, the ET-1 level in uterine tissues of rats in group Eobviously decreased（p 0.05）. Comparison of NO level： compared with（6.63±1.83） in group A, the NO level in uterine tissues of rats in group B（1.62 ±0.58） significantly decreased（p 0.01）. Compared with group B, the NO level in uterine tissues of rats in group C（3.60±0.59）,group D（4.77 ±0.67） and group E（5.99±0.63） obviously increased（all p 0.01）. Compared with group C,the NO level in uterine tissues of rats in group Dand group E obviously increased（p 0.05, p 0.01）. Compared with group D, the NO level in uterine tissues of rats in group E obviously increased（p 0.01）.Conclusion： The analgesic effect of mild moxibustion at different intervention times on cold-damp coagulation and stagnation type dysmenorrhea rats was different, which was the most significant in pre-instant moxibustion group. One of the mechanisms of action may be related with the adjustment of abnormal levels of ET-1 and NO.