Use of Evidence-Based Research Approach in RCTs of Acupuncture-Related Therapies for Primary Dysmenorrhea: A Meta-Research

Objective To assess the use of evidence-based research(EBR)approach in randomized controlled trials(RCTs)of acupuncture-related therapies for primary dysmenorrhea(PD).Methods PubMed,EMBASE,Cochrane Library,China National Knowledge Infrastructure,Wanfang Database,Chinese Biomedical Database,and China Science and Technology Journal Database were searched from January 2013 to December 2022 for RCTs of acupuncture on PD.The full text and references of each RCT were read to assess whether systematic reviews(SRs)or other types of studies with similar research questions and end-users’perspectives were cited to justify and design the trial.In addition,the discussion section were analyzed to evaluate whether trials placed the new result in the existing SRs to draw a conclusion.Multivariable logistic regression was used to find variables that associated with 3 aspects of EBR approach:(1)citing clinical studies for justification,(2)citing relevant studies that obtain the perspectives of end users,and(3)citing clinical studies for results discussion.Results Of 473 RCTs included,45.67%(216)of the trials cited relevant similar studies,21.56%(102)referenced to the studies that collected end-users’perspectives,and 10.99%(52)placed result in the context of the previous research.Few RCTs appropriately applied EBR approach.Among all the included studies,3.17%(15)of the trials used SRs to inform study questions but none of them used updated SRs with acceptable quality;1.05%(5)of the trials cited SRs of end-user’s perspectives in the justification and design of the study,and only 1 trial added results in existing SR to draw a conclusion.Year of publication,language,funding,registration,ethical approval and number of sites were significantly associated with 1 of the 3 aspects of EBR approach.Conclusions Few RCTs in acupuncture-related therapies for PD used the EBR approach to minimize research redundancy.Researchers,research institutes,funding agencies,ethics committees,journals and peer reviewers in acupuncture should make efforts to use and promote the EBR approach to ensure the value of new trials.

Clinical observation on 90 cases of primary dysmenorrhea treated by buccal acupuncture therapy:a randomized controlled study

OBJECTIVE:To explore the short-term and long-term efficacy of buccal acupuncture therapy in the treatment of patients with primary dysmenorrhea(PD).METHODS:A total of 90 patients with PD who were admitted to the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from January 2020 to December 2021 were included in this study and randomly divided into three groups,including the observation group,the control group,and the placebo group,with 30 patients in each group.Patients in the observation group were treated according to the syndrome types of Traditional Chinese Medicine,those in the control group were treated with Saridon,and those in the placebo group received a placebo.The visual analog scale(VAS)scores of these patients were evaluated at different time points(before treatment,5 min after needle retention,30 min after needle retention,1 h after treatment,2 h after treatment,1 d after treatment,and 2 d after treatment).The Cox Menstrual Symptom Scale(CMSS)scores were assessed before the treatment and after three courses of treatment.Besides,these two scales were also evaluated during follow-up.Moreover,the pain score and adverse reactions of these patients were assessed during treatment.RESULTS:After treatment,the VAS and CMSS scores in the observation group decreased significantly(P<0.05)5 and 30 min after needle retention and after treatment.CONCLUSION:Buccal acupuncture therapy is verified to have short-term efficacy in the treatment of PD.In addition,this therapy has an immediate analgesic effect and long-term efficacy in reducing the severity and frequency of PD.

ACUPUNCTURE TREATMENT OF DYSMENORRHEA

Case HistoryPatient Wang, a female universitystudent aged 21 years, paid her first visit onAug. 16, 1990, with the chief complaint ofdysmenorrhea for one year. The patientcomplained that in the summer of 1989, oneday during her menstrual period when

INFLUENCE OF DIFFERENT INTERVALS OF ACUPUNCTURE TREATMENT ON BONE INTENSITY IN PRIMARY OSTEOPOROSIS PATIENTS

Objective: To observe the influence of different intervals of acupuncture treatment on bone intensity in primary osteoporosis subjects. Methods: A total of 45 cases of primary osteoporosis female patients were randomly divided into 1 treatment/week (1-T/W), 2 treatments/week (2-T/W) and 3 treatments/week (3-T/W) groups, with 15 cases being in each group. Guanyuan (CV 4), Zusanli (ST 36), Sanyinjiao (SP 6), Shenshu (BL 23), Taixi (KI 3) and Pishu (BL 20) were used and stimulated with reinforcing needling manipulation. For patients with deficiency syndrome of kidney-yang, thermal acupuncture was applied to Shenshu (BL 23), and for patients with spleen-deficiency syndrome, thermal acupuncture applied to Zusanli (ST 36). Results: After 6 months’ treatment, in 1-T/W group, no apparent change of bone intensity was observed, while in 2-T/W and 3-T/W groups, the bone intensity was increased significantly (P<0.05, 0.01). Conclusion: Acupuncture plus moxibustion treatment twice or 3 times every week can obviously improve the bone intensity.

China Association of Acupuncture–Moxibustion Evidence-based clinical practice guideline of acupuncture and moxibustion: Primary dysmenorrhea

Dysmenorrhea refers to periodic abdominal pain,or radiating to lumbosacral region.For the severe case,it is intolerable,combined with nausea and vomiting sometimes.This disease is commonly seen in unmarried young women.Epidemiological studies have shown that dysmenorrhea is the most common gynecological disease,especially in young women[1].Acupuncture and moxibustion have a long history in the treatm ent of primary dysmenorrhea(hereinafter referred to as PD),and compared with medication,the advantages are presented in the treatment.Entrusted by the Standardization Working Committee of China Association for Acupuncture and Moxibustion(CAAM),Department of Acupuncture and Moxibustion,Dongzhimen Hospital,Beijing University of Traditional Chinese Medicine has undertaken the drafting of Evidence-Based Clinical Practice Guideline of Acupuncture and Moxibustion:Primary Dysmenorrhea(hereinafter referred to as the Guideline).The Guideline was issued in 2014 by CAAM.It summarizes the research achievements in acupuncture-moxibustion treatm ent for dysmenorrhea in recent decades and is intended to standardize the clinical regimen of treatm ent with acupuncture and moxibustion so as to improve the clinical effect.

CLINICAL APPLICATION OF CILIAO IN ACUPUNCTURE TREATMENT

Ciliao(UB 32),located at the 2ndposterior sacral foramen,is the point of theBladder Meridian.According to the literature,the indications of Ciliao include low back pain,

壮医针灸治疗寒凝血瘀型原发性痛经疗效观察

目的:观察壮医针灸治疗寒凝血瘀型原发性痛经的临床疗效。方法:选取2020年6月-2021年6月广西中医药大学第一附属医院壮医针灸科60例原发性痛经患者,按照随机数字分组法分为观察组和对照组,每组各30例。对照组采用布洛芬片口服治疗;观察组采用壮医针灸治疗。连续治疗3个月经周期。分别在治疗1月后、治疗3月后及疗程后1个月比较两组患者VAS视觉模拟评分及中医证候积分变化,观察治疗3个月经周期后,两组患者治疗的临床疗效和不良反应发生率。结果:经治疗后,两组患者各时间点VAS评分及中医证候积分与治疗前比较,均得到明显改善(P<0.05)。组间比较,观察组中医证候积分改善程度均优于对照组,且起效快,疗效更稳定(P<0.05);观察组临床疗效优于对照组,不良反应发生率也低于对照组,差异均有统计学意义(P<0.05)。结论:壮医针灸治疗寒凝血瘀型原发性痛经起效快,能明显减轻疼痛程度,临床疗效显著、稳定,且无痛、操作简便,副作用少,值得临床推广应用。

灵龟八法针刺配合热敏灸治疗原发性痛经的疗效观察及对子宫动脉血流动力学指标的影响

目的 观察灵龟八法按时开穴针刺配合热敏灸治疗原发性痛经的临床疗效及其对子宫动脉血流动力学指标的影响。方法 将60例原发性痛经患者随机分为治疗组和对照组,每组30例。对照组予口服布洛芬缓释胶囊治疗,治疗组予灵龟八法按时开穴针刺配合热敏灸治疗。观察两组治疗前后的子宫动脉血流动力学指标[子宫动脉阻力指数(resistance index, RI)、搏动指数(pulsatility index, PI)和收缩期峰值/舒张期峰值]、中医证候积分、COX痛经症状量表(Cox menstrual symptom scale, CMSS)评分和视觉模拟量表(visual analog scale,VAS)评分的变化,并比较两组临床疗效及不良反应情况。结果 治疗组的总有效率为90.0%(27/30),高于对照组的76.7%(23/30)(P<0.05)。治疗后,两组VAS评分、中医证候评分和CMSS评分均较治疗前降低(P<0.05),且治疗组低于对照组(P<0.05)。治疗后,两组RI、PI和收缩期峰值/舒张期峰值均较治疗前降低(P<0.05),且治疗组各项指标明显低于对照组(P<0.05)。治疗组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论灵龟八法按时开穴针刺配合热敏灸治疗原发性痛经效果显著,可有效减轻患者的疼痛症状及缩短痛经时间,改善子宫微循环,缓解平滑肌痉挛。

转化医学视角下针灸治疗原发性痛经的研究现状与思考

针灸是治疗原发性痛经的有效手段。转化医学理念为针灸学传承创新与发展开辟了新的路径,同样为针灸治疗本病带来了新的机遇。基于转化医学视角,对本病的针灸研究成果向临床标准的转化和针灸创新发明向技术产品的转化进行述评,并讨论当前针灸转化医学存在的问题。从组方选穴、针灸时机和针法参数三个方面筛选整合近年文献,期望助力本病针灸标准化操作的优化。从针灸新材料、针灸新设备两个方面对典型专利技术转让产品进行列举,为针灸特色技术产品的创新研发与成果转化提供思路,以期促进针灸转化医学研究,让针灸更好、更快、更直接服务临床和社会。

针灸刺激任脉治疗原发性痛经概述及其病例注册登记研究展望

文章系统、全面地分析了针灸刺激任脉治疗原发性痛经的现状,从文献研究及临床研究两方面进行概述,发现关元、气海、中极、神阙是目前较为常用的任脉穴位。同时发现目前关于针灸刺激任脉治疗原发性痛经的临床研究缺乏高质量的循证医学依据。通过梳理相关文献,认为面对国际“去经络化”的倾向,病例注册登记研究更能体现针灸特色,符合中医辨证论治的观念,能最大程度地还原临床复杂的干预情况,节约资源并提高效率。同时病例注册登记研究也面临诸多挑战,如数据管理与数据共享、数据利用等。因此提出搭建病例注册登记平台并开展病例注册登记研究,收集真实世界数据,为针灸刺激任脉治疗原发性痛经提供临床依据具有重要意义。参考文献29篇。

痛经汤与隔药灸治疗寒凝血瘀型原发性痛经临床观察

目的分析痛经汤联合隔药灸治疗寒凝血瘀型原发性痛经的临床效果。方法选取南昌市洪都中医院2020年5月—2022年5月收治的62例寒凝血瘀型原发性痛经患者作为研究对象,采用随机数字表法将其分为参照组与研究组,各31例。参照组给予痛经汤治疗,研究组在参照组基础上加用隔药灸治疗。比较两组治疗前后中医证候积分、血清前列腺素F2α。结果治疗后,研究组中医证候积分为(7.63±2.57)分,低于参照组的(9.25±2.95)分,差异有统计学意义(P<0.05)。治疗后,研究组血清前列腺素F2α水平低于参照组,差异有统计学意义(P<0.05)。结论采用痛经汤联合隔药灸治疗寒凝血瘀型原发性痛经患者,可改善其中医症状,降低其前列腺素水平。

不同灸量隔药灸治疗原发性痛经寒凝血瘀证临床观察

目的探讨不同灸量隔药灸治疗原发性痛经寒凝血瘀证的临床效果。方法选择上饶市妇幼保健院妇科于2020年1月—2021年12月收治的原发性痛经寒凝血瘀证患者68例,根据采用的方法不同将其分为观察组(34例)与对照组(34例),观察组患者每次每穴隔药灸治4壮,对照组患者每次每穴隔药灸治8壮,确保对两组患者每个月经周期施灸7次,持续3个月,比较两组治疗前后中医证候评分、视觉模拟量表(VAS)评分、持续痛经时间。结果观察组患者临床治疗有效率为91.2%(31/34),高于对照组的73.5%(25/34),但差异无统计学意义(P>0.05)。两组患者治疗前后的VAS评分及疼痛持续时间均得到显著改善(P<0.05)。结论隔药灸可改善原发性痛经寒凝血瘀证患者的疼痛症状,缩短疼痛持续时间,有很好的疗效,而不同灸量对疗效的影响不大,文章建议应用4壮治疗。

分期“十字灸”疗法治疗寒凝血瘀型原发性痛经临床观察

目的:观察分期“十字灸”疗法治疗寒凝血瘀型原发性痛经(primary dysmenorrhea,PD)的疗效。方法:选取寒凝血瘀型PD患者72例,按照随机数字表法分为十字灸组和布洛芬组各36例。布洛芬组在月经来潮疼痛时口服布洛芬缓释胶囊治疗,十字灸组给予分期“十字灸”疗法治疗。观察两组治疗前后视觉模拟评分(visual analogue score,VAS)、血清前列腺素F2α(prostaglandin F2α,PGF2α)变化情况及临床疗效。结果:十字灸组治疗后PGF2α水平低于布洛芬组,差异具有统计学意义(P<0.05);十字灸组治疗后及随访VAS评分均低于布洛芬组,差异具有统计学意义(P<0.05);布洛芬组有效率为69.4%,十字灸组有效率为91.7%,十字灸组有效率高于布洛芬组,差异具有统计学意义(P<0.05)。结论:分期“十字灸”疗法治疗寒凝血瘀型原发性痛经近期、远期疗效均优于布洛芬缓释胶囊,其作用机制可能与通过减少子宫内膜产生和释放PGF2α相关。

Efficacy Observation on Acupuncture Combined with Auricular Point Sticking Treatment for Primary Dysmenorrhea

Objective:To observe the clinical efficacy of acupuncture combined with auricular point sticking treatment for primary dysmenorrhea. Methods:Sixty-eight patients with primary dysmenorrhea were randomly divided into two groups, and 35 cases in the treatment group were treated by acupuncture combined with auricular point sticking, while 33 cases in the control group were only treated by acupuncture. The treatments for the patients in both groups began from one week before their menstruation and continued till the menstruation came. And the efficacy was observed after treatments of three consecutive menstrual cycles. Results:The total effective rate was 94.2% in the treatment group, versus 84.8% in the control group, and the difference was statistically significant (P<0.05). Conclusion:Acupuncture combined with auricular point sticking treatment for primary dysmenorrhea is more effective than simple acupuncture.

Warm Needle Moxibustion Therapy for 41 Cases of Dysmenorrhea

Dysmenorrhea means that women feels periodicalpain in the lower abdomen or lumbosacmm,before,during or after menstruation.The pain can beintolerable and affects the work and daily life.Dysmenorrhea is divided into two categories:primaryand secondary,of which those without organic

网状Meta分析6种常见针灸疗法治疗原发性痛经的疗效与安全性

目的:基于贝叶斯网状Meta分析评价6种针灸疗法治疗原发性痛经(PD)的临床疗效与安全性。方法:计算机检索PubMed、Web of science等数据库,搜集6种常见针灸疗法(针刺、针灸、艾灸、温针灸、电针及穴位埋线)治疗PD的随机对照试验研究文献,检索时限为2000年1月1日-2020年9月30日。由2位研究者独立筛选文献、提取数据和评价纳入研究的偏倚风险。采用R软件进行数据分析,以Stata16.0软件绘制网状证据图。结果:共纳入98项随机对照试验研究,总计7 410例PD患者,涉及8种干预措施。所有结局指标均显示随机效应模型整体拟合度较好,可以在一致性模型下进行网状Meta分析。在有效率方面,针刺、艾灸、针灸、温针灸、电针、穴位埋线均优于空白或安慰剂、非甾体类抗炎药,针灸、温针灸均优于针刺及艾灸,有效率排序第一为温针灸。在疼痛缓解方面,针灸的效果优于针刺及艾灸,除艾灸与电针外,其余干预措施缓解疼痛的效果均优于非甾体类抗炎药,缓解疼痛效果排序第一为针灸。在安全性方面,各干预措施之间比较,差异无统计学意义,均表现出良好的安全性。结论:6种针灸疗法治疗PD的临床疗效均优于非甾体类抗炎药,针灸与温针灸可成为临床治疗PD的首选疗法。

隔药灸配合中药口服治疗寒凝血瘀型原发性痛经临床观察

目的探讨隔药灸配合中药口服治疗寒凝血瘀型原发性痛经的临床效果。方法选取2020年1月—2020年12月在南昌市洪都中医院就诊的寒凝血瘀型原发性痛经患者75例,按随机数字表法将其分为西药组及中药组,西药组37例,中药组38例。西药组患者采用布洛芬治疗,中药组在西药组的基础上,使用隔姜灸的同时口服温经汤治疗。3个疗程后,观察2组患者的临床治疗效果;评估2组患者的经期疼痛程度及疼痛持续时间;检测2组患者的β-内啡肽(β-EP)及前列腺素E2(PGE2)的水平。结果3个疗程后,中药组总有效率为92.11%(35/38),高于对照组的72.97%(27/37);中药组疼痛程度低于西药组,疼痛持续时间短于西药组;中药组患者的PGE2水平低于西药组,β-EP水平高于西药组,差异均有统计学意义(P<0.05)。结论隔药灸配合中药口服治疗寒凝血瘀型原发性痛经,可在减轻患者疼痛程度的基础上,缩短患者疼痛时间,有效抑制机体疼痛介质因子的释放,临床效果显著。

艾灸联合五音疗法对原发性痛经的疗效研究

目的 探讨艾灸联合五音疗法治疗原发性痛经的效果。方法 选取80例原发性痛经患者为研究对象,并将其随机分为干预组、对照组,每组40例。对照组行常规护理,疼痛明显时口服布洛芬缓释胶囊;干预组在对照组的基础上增加艾灸联合五音疗法治疗,两组均治疗3个月经周期。比较两组疗效,以及治疗前、治疗3个月经周期后两组患者的经期疼痛程度[采用数字评分法(NRS)]、痛经症状严重程度和持续时间[采用COX痛经症状量表(CMSS)]。结果 3个月经周期后,干预组疗效优于对照组,NRS评分、CMSS痛经症状严重程度和症状持续时间评分均低于对照组(均P<0.05)。结论 艾灸联合五音疗法治疗原发性痛经效果明显,可有效地减轻经期疼痛,缓解经期症状,提高患者舒适度。

近5年针灸治疗青春期原发性痛经研究进展

原发性痛经是青春期女性常见的妇科疾患之一,近年来发病率显著上升,且程度不断加剧,严重影响青春期女性学习、工作效率和生活质量。笔者通过查阅近5年相关文献发现,原发性痛经好发于青春期女性,现代医学治疗青春期痛经的首选药物为非甾体抗炎药、孕激素和口服避孕药,短期内疗效突出,但是长期疗效不佳,容易形成依赖并且存在胃肠道不良反应的风险性。目前针灸是治疗痛经的方法之一,本文通过对查阅的相关文献进行分析、整理,发现针灸治疗青春期原发性痛经的方法较为丰富,主要包含针刺、艾灸、揿针、耳针、穴位贴敷以及联合疗法等,以上方法在改善痛经症状、缓解疼痛程度等方面均收效显著,其机制与改善前列腺素、内分泌激素水平有关。

针刺配合艾灸治疗水上项目女运动员寒湿凝滞型原发性痛经疗效观察

目的:观察针刺配合艾灸治疗水上项目女运动员寒湿凝滞型原发性痛经疗效。方法:将52例水上项目寒湿凝滞型原发性痛经女运动员按随机数字表法分为观察组和对照组各26例。对照组采用布洛芬缓释胶囊治疗,观察组采用针刺配合艾灸治疗。比较两组治疗前后疼痛视觉模拟评分(VAS)和痛经症状积分。结果:治疗第1、2、3个疗程后观察组和对照组VAS评分和痛经症状积分较治疗前均降低,且观察组治疗后VAS评分和痛经症状积分均低于对照组,差异均有统计学意义(P<0.05)。结论:针刺配合艾灸治疗水上项目女运动员寒湿凝滞型原发性痛经疗效显著,可以有效改善患者痛经症状。