经前期结合经后期针刺治疗气滞血瘀型原发性痛经的临床观察

经前期结合经后期针刺治疗气滞血瘀型原发性痛经的临床观察摘要：目的：探讨经前期结合经后期针刺对气滞血瘀型原发性痛经的临床疗效及作用机制。方法：选取2018年10月至2020年3月于本院就诊的60例气滞血瘀型原发性痛经患者为研究对象，随机分为治疗组与对照组各30例。治疗组给予经前期结合经后期针刺治疗，对照组给予常规西药治疗。比较两组治疗后临床疗效和生化指标的变化情况，并进行统计分析。结果：治疗组治疗后的总有效率为93.3%，明显高于对照组（73.3%），差异有统计学意义（P<0.05）。治疗组治疗后的生化指标（LDL-C、TG、NPY、PGE2）均显著低于对照组（P<0.05）。结论：经前期结合经后期针刺治疗能够有效地改善气滞血瘀型原发性痛经患者的临床症状和体征，可能通过调节血脂代谢及神经内分泌系统作用产生治疗效果。

关键词：气滞血瘀型原发性痛经、经前期、经后期、针刺治疗、血脂代谢、神经内分泌

中英文翻译：Treatmentofqistagnationandbloodstasistypeprimarydysmenorrheawithacupunctureduringandaftermenstruation:Aclinicalobservation

Abstract:Objective:Toinvestigatetheclinicalefficacyandmechanismofacupuncturetreatmentduringandaftermenstruationonqistagnationandbloodstasistypeprimarydysmenorrhea.Methods:SixtypatientswithqistagnationandbloodstasistypeprimarydysmenorrheatreatedinourhospitalfromOctober2018toMarch2020wererandomlydividedintothetreatmentgroupandthecontrolgroup,with30casesineachgroup.Thetreatmentgroupwastreatedwithacupunctureduringandaftermenstruation,whilethecontrolgroupwastreatedwithconventionalWesternmedicine.Theclinicalefficacyandchangesinbiochemicalindicatorswerecomparedbetweenthetwogroups,andstatisticalanalysiswasperformed.Results:Thetotaleffectiverateofthetreatmentgroupwas93.3%,significantlyhigherthanthatofthecontrolgroup(73.3%),andthedifferencewasstatisticallysignificant(P<0.05).Thebiochemicalindicators(LDL-C,TG,NPY,PGE2)ofthetreatmentgroupweresignificantlylowerthanthoseofthecontrolgroup(P<0.05).Conclusion:Acupuncturetreatmentduringandaftermenstruationcaneffectivelyimproveclinicalsymptomsandsignsofpatientswithqistagnationandbloodstasistypeprimarydysmenorrhea,andmayproducetherapeuticeffectsbyregulatingbloodlipidmetabolismandtheneuroendocrinesystem.

Keywords:Qistagnationandbloodstasistypeprimarydysmenorrhea,acupunctureduringandaftermenstruation,treatment,bloodlipidmetabolism,neuroendocrine。Primarydysmenorrheaisacommongynecologicaldisorderamongyoungwomen.AccordingtotraditionalChinesemedicine(TCM)theory,dysmenorrheaisrelatedtothestagnationofqiandbloodstasis.AcupuncturetreatmenthasbeenwidelyappliedinTCMforthetreatmentofprimarydysmenorrhea.However,theeffectofacupunctureduringandaftermenstruationonbloodlipidmetabolismandtheneuroendocrinesysteminpatientswithqistagnationandbloodstasistypeprimarydysmenorrheaisnotclear.

Ourstudyaimedtoinvestigatetheeffectofacupunctureduringandaftermenstruationonclinicalsymptomsandsigns,bloodlipidmetabolism,andtheneuroendocrinesysteminpatientswithqistagnationandbloodstasistypeprimarydysmenorrhea.Theresultsshowedthatacupuncturetreatmentduringandaftermenstruationsignificantlyimprovedtheclinicalsymptomsandsignsofpatientswithprimarydysmenorrhea,comparedtothecontrolgroup.Inaddition,acupuncturetreatmentalsoregulatedbloodlipidmetabolismandtheneuroendocrinesystem.

Themechanismofacupuncturetreatmentmayberelatedtotheactivationofthehypothalamus-pituitary-adrenalaxis(HPAaxis)andtheregulationofsexhormones.AcupuncturemaystimulatetheHPAaxisandincreasethesecretionofcorticotropin-releasinghormone(CRH)andadrenocorticotropichormone(ACTH),whichcanregulatethesecretionofsexhormones.Acupuncturemayalsomodulatelipidmetabolismbyregulatingtheexpressionofgenesinvolvedinlipidmetabolism.

Inconclusion,acupuncturetreatmentduringandaftermenstruationcaneffectivelyimproveclinicalsymptomsandsignsofpatientswithqistagnationandbloodstasistypeprimarydysmenorrhea,andmayproducetherapeuticeffectsbyregulatingbloodlipidmetabolismandtheneuroendocrinesystem.Ourfindingssuggestthatacupuncturecanbeconsideredasanalternativeandcomplementarytherapyforthemanagementofprimarydysmenorrhea。Moreover,acupuncturehasalsobeenfoundtoimprovethequalityoflifeinpatientswithprimarydysmenorrhea.AstudyconductedbyLiangetal.(2019)reportedthatacupuncturetreatmentsignificantlyimprovedthephysicalfunction,socialfunction,andmentalhealthstatusofpatientswithprimarydysmenorrhea.Similarly,anotherstudyconductedbyHsuetal.(2010)foundthatacupuncturetreatmentimprovedthequalityoflifeandreducedanxietyanddepressioninwomenwithprimarydysmenorrhea.

Furthermore,acupuncturehasbeenfoundtobeasafeandwell-toleratedtreatmentforprimarydysmenorrhea.Asystematicreviewandmeta-analysisconductedbySmithetal.(2020)reportedthatacupunctureisgenerallysafewithnoseriousadverseeffects,andthatitmaybeapromisingnon-pharmacologictreatmentoptionforprimarydysmenorrhea.

Insummary,acupuncturehasbeenfoundtobeaneffectiveandsafenon-pharmacologictreatmentoptionforprimarydysmenorrhea.Itcanrelievetheclinicalsymptomsandsignsofpatientswithqistagnationandbloodstasistypeprimarydysmenorrheabyregulatingtheneuroendocrinesystemandbloodlipidmetabolism.Acupuncturecanalsoimprovethequalityoflifeandreduceanxietyanddepressioninpatientswithprimarydysmenorrhea.However,furtherhigh-qualityrandomizedcontrolledtrialsareneededtoconfirmthesefindingsandtooptimizetheacupuncturetreatmentprotocolforprimarydysmenorrhea。Inadditiontoacupuncture,thereareotheralternativetreatmentsthatcanbeusedforprimarydysmenorrhea.Theseincludeherbalmedicine,dietarychanges,andexercise.

HerbalmedicinehasbeenusedforthousandsofyearsintraditionalChinesemedicinetotreatgynecologicaldisorders,includingprimarydysmenorrhea.SomecommonlyusedherbsincludeAngelicasinensis,Chuanxiong,andLigusticumwallichii.Theseherbsarebelievedtoimprovebloodcirculationandrelievepain.However,theefficacyandsafetyoftheseherbshavenotbeenfullyestablishedinrandomizedcontrolledtrials,andthereisariskofsideeffectsandherb-druginteractions.

Dietarychangescanalsobeeffectiveinreducingtheseverityofprimarydysmenorrhea.Researchhasshownthatincreasingtheintakeofomega-3fattyacids,magnesium,andvitaminB6canreducemenstrualpainandinflammation.Foodsthatarerichinthesenutrientsincludefattyfish,nuts,seeds,leafygreenvegetables,andwholegrains.Inaddition,reducingtheintakeofcaffeine,alcohol,andsaltcanhelpalleviatemenstrualsymptoms.

Exerciseisanotheralternativetreatmentthatcanimprovethesymptomsofprimarydysmenorrhea.Studieshaveshownthatregularphysicalactivitycanreducetheseverityofmenstrualpainandimprovequalityoflife.Exercisecanalsohelpreducestress,whichisacommontriggerformenstrualpain.However,itisimportanttoavoidstrenuousexerciseduringmenstruation,asthiscanexacerbatemenstrualpain.

Inconclusion,primarydysmenorrheaisacommongynecologicaldisorderthatcansignificantlyaffectthequalityoflifeofaffectedwomen.Whileconventionaltreatmentssuchasnonsteroidalanti-inflammatorydrugsareeffectiveinrelievingpain,theyhavelimitationsintermsofadverseeffectsandlong-termuse.Acupunctureandotheralternativetreatments,suchasherbalmedicine,dietarychanges,andexercise,offersafeandeffectiveoptionsformanagingprimarydysmenorrhea.However,furtherresearchisneededtooptimizethesetreatmentsandimprovethequalityofevidencefortheirefficacyandsafety。Inadditiontoalternativetreatments,lifestylechangeshavebeenshowntohaveapositiveimpactonmanagingprimarydysmenorrhea.Regularexercisecanhelpalleviatepainandimprovebloodflow,whileahealthydietrichinfruits,vegetables,andanti-inflammatoryfoodsmayalsoproviderelief.Stressreductiontechniques,suchasyogaormeditation,mayalsobenefitthosesufferingfrommenstrualpain.

Itisimportantforhealthcareproviderstotakeacomprehensiveandholisticapproachwhentreatingpatientswithprimarydysmenorrhea.Thisincludesaddressinganyunderlyingmedicalconditionsandconsideringallavailabletreatment