| Dysmenorrhea is one of the most common gynecologic complains. Symptoms of dysmenorrhea include pelvic pain with nauses, diarrhea, fatigue and lower back sore that usually occur just before or during menstruation and give much impact on patients'life quality. Abundance of epidemiologic surveys show that the incidence of dysmenorrhea is relatively high. However, majority of women with dysmenorrhea just bear the pain and do not seek medical advice. In fact, the pain can not only affect normal work, but also conceal illnesses and delay the diagnosis and treatment of serious gynecologic diseases, and even threaten to pregnancy and life. Nonsteroidal anti-inf lammatory drugs (NSAIDs) and oral contraceptive pills are common therapy for dysmenorrhea in western medicine, but have many side-effects. Since the differentiation of each dysmenorrhea person, Chinese herbal medicine doesn't work very well.Acupuncture and moxibustion has many advantages on treating dysmenorrhea, such as reliable curative effect, easy management, low price, no toxic side-effects, and could be accepted by many people.And the measures of stimulations are controlled objectively and are easily quantitatively analyzed by electric-acupuncture. However, since the numerous and jumbled acupoints treating dysmenorrhea in clinic and less of standard researches on acupoints, it is hard to select acupoints to treat dysmenorrhea. Therefore, how to choose the most effective acupoints are important task in acupuncture fiuld.The aim of this task is to discuss the specificity of acupoints on treating uterus related diseases and dysmenorrhea by acupuncture and moxibustion, investigate the occurring rate and distributing of different patterns of dysmenorrhea. From literature reviews, literature researches and epidemiology of dysmenorrhea, this subject analyses the rule of choosing acupoints on treating uterus related diseases and dysmenorrhea by acupuncture and moxibustion and the reasons and characteristics of patterns'distributing of dysmenorrhea, in order to provide evidences to choosing acupoints in clinic and patients source and other information for large sample size clinical trial on dysmenorrhea.In addition, this subject exploringly observed the effects on primary dysmenorrhea by electric-acupuncturing Sanyinjiao by analyzing the trend of results of the small sample size trial in order to offer some references on selecting"no-related acupoints"for formal clinical trials.This thesis displays four sections: literature reviews, literature researches, epidemiology research of dysmenorrhea and postscript.First Section: literature ReviewsThere are two reviews. First review: The cognitions on pathogenesis of dysmenorrhea and diseases related to uterus by TCM and western medicine.The fuctions of the uterus according to Chinese medicine are tightly related with bowels and viscera, meridians and collatrals, qi and blood. Deficiency of kidney qi, deficiency of qi and blood, stagnation of qi and blood, cold stagnation, heat dampess could lead to deficiency or stagnation of qi and blood of Ren and Du meridians and cause dysmenorrhea.In western medicine, dysmenorrhea is divided into two types: primary and secondary. Primary dysmenorrhea is related to such factors as incretion, nerve and nerve transmitter, Calcium ion, magnesium ion, inheritance, immunity, environment, emotion, etc. Secondary dysmenorrhea can be caused by endometriosis, adenomyosis, chronic pelvic inflammatory disease, gynecological tumour, conglutination and straitness of uterine neck. Second review: Ancient usages and modern researches on SanyinjiaoThis review discussed the naming, location, functions and clinical use of Sanyinjiao from both ancient and modern literatures. The acupoint is located on the medial side of the shank, 3 cun directly above the tip of the medial malleolus, on the posterior border of the medial aspect of the tibia. It is the crossing point of there yin Meridians of Foot. It can invigorating spleen, releasing liver-qi and reinforcing kidney. Modern medicine discovered that the morphological structure of Sanyinjiao is multihierarchical and tridimensional. This acupoint can treat large range of diseases. Antient literature involved diseases of spleen, stomach, gynecology, kidney, bladder, lung, heart, brain, etc. Modern clinical and experimental researches involved disease of reproductive, urinary, digestic, immune and endocrine systems and pain. Second Section: literature researches Specificity of acupoints by treating diseases related to uterus and dysmenorrhea with acupuncture and moxibustionThere are two researches.First research: Specificity of acupoints by treating diseases related to uterus with acupuncture and moxibustion42 ancient literatures before Qing Dynasty which are about acupuncture treating diseases related to uterus, were refered. There are 104 points are related to uterus diseases according to the statistic. In these points, SanYinJiao used most, and then Zhongji, Qihai, Guanyuan, etc. The meridians which 104 points belong to are 12 meridians, Ren Meridian and Du Meridian. The most used is Ren Meridian and Kidney Meridian, then Spleen Meridian, Bladder Meridian, Stomach Meridan, etc.294 modern literatures from 1979 to 2007 on CNKI database, which are about acupuncture treating diseases related to uterus, were refered. There are 73 points are related to uterus diseases. In these points, SanYinJiao used most, and then Guanyuan, Zhongji, Zusanli, Qihai, Ciliao, etc.The meridians which 73 points belong to involve 11 meridians (except Small Interstine Meridian), Ren Meridian and Du Meridian. The most used is Spleen Meridian, the Ren Meridian, Bladder Meridian, Stomach Meridan, Liver Meridian, etc.Ancient and modern literatures were collected and rules of selecting points of treating uterus related diseases are preliminarily concluded: Sanyinjiao is the main point in clinic; points on lower abdomen (which mostly belong to Ren Meridian) and points on lower lumb (which mostly belong to Bladder Meridian) are often used; the often used points below knee are generally belong to three Yin Meridans of Foot.Second research: Specificity of acupoints by treating dysmenorrhea with acupuncture and moxibustion.25 ancient literatures which are about acupuncture treating dysmenorrhea, were refered. There are 38 points are related to dysmenorrhea according to statistic. In these points, Sanyinjiao is the most used one, then Yinjiao, Shuidao, Siman, Neiting, Guanyuan, etc. The meridians which 38 points belong to involve Stomach Meridian, Ren Meridian, Kidney Meridian, Bladder Meridian, Spleen Meridian, Large Intestine Meridian, Gallbladder Meridian, Liver Meridian, Pericardium Meridian, and Stomach Meridian is the most used one. Du Meridian, Heart Meridian, Three Burners Meridian, Small Intestine Meridian, Lung Meridian are not involved.185 modern literatures from 1992 to 2007 on CNKI database, which are about acupuncture treating dysmenorrhea, were refered. There are 47 points are related to dysmenorrhea. In these points, SanYinJiao is the most used one, then GuanYuan, Zhongji, Qihai, Zusanli, Ciliao, etc. The meridians which 47 points belong to involve Ren Meridian, Du Meridian, Spleen Meridian, Kidney Meridian, Liver Meridian, Bladder Meridian, Stomach Meridian, Heart Meridian, Large Intestine Meridian, Pericardium Meridian, Gallbladder Meridian, and Spleen Meridian is the most used one. Lung Meridian, Small Intestine Meridian and Three Burners Meridian are not involved.Ancient and modern literatures were collected and rules of selecting points of treating uterus related diseases are preliminarily concluded: Sanyinjiao is the main point in clinic; points on lower abdomen (which mostly belong to Ren Meridian) and points below knee (which mostly belong to three Yin Meridans of Foot) are often used.Third Section: Epidemiology research on dysmenorrheaQuestionnaire on menstruation and dysmenorrhea of university girlsObjective: To know the incidence of menstruation and dysmenorrhea of female students in a university. Method: 1,000, self-made questionnaires were conducted to female students from different specialties and grades to investigate their detailed information of menstruation and dysmenorrhea. Statistical analysis was made after they returned the questionnaires. Result: 1,000, questionnaires were provided and 973 were returned. The analysis showed that the age of menarche was mainly around 12 to 15 years old, which accounted for 86.20%. The average age of menarche was 13.28±1.36 years. 50.67% of 973 schoolgirls had painful menstruation. Many students had other premenstrual or menstrual disturbances. Discussion:①The average age of menarche of girls are smaller than before, which could be related to the improvement of life standard;②Because of the heavy burden of study and irregular dietary and habits, many students of grade 2 and 4 have dysmenorrheal;③Drinking cold water,intensity and irregular emotion could lead to block of coldness and dampness or stagnation of qi and blood, then lead to dysmenorrhea.Fourth Section: PostscriptElementary observation of effects on primary dysmenorrhea by electric-acupuncturing SanyinjiaoObjective: elementarily observation of effects of Sanyinjiao by comparison of effects of Sanyinjiao and other acupoints with electric-acupuncture for primary dysmenorrhea.Methods: 6 patients who met the including criteria of primary dysmenorrhea had been assigned into 2 groups with 3 cases in each group. The 2 points were San Yin Jiao and Xuan Zhong. The frequency of electric-acupuncture was 2/100 Hz, and the intensity was bearable. The needles were kept for 30 minutes. This treatment began at the first day of menstrual pain with VAS score more than 40mm, and lasted for 3 days with 1 time per day.Results:1. VAS Scores:VAS scores of Sanyinjiao group and Xuanzhong group: Sanyinjiao group had relatively better analgetic effects than Xuanzhong group on each time point.2. RSS Scores:Sanyinjiao group's and Xuanzhong group's ratios of difference (anterior score– latter score / anterior score) of RSS-COX2 score in first day's treatment had no differences. However, being compared by mean scores, after 1st day's treatment, Xuanzhong group's ratio of difference of RSS score was little more than that of Sanyinjiao group; while after 2nd day's treatment, Sanyinjiao group's ratio of difference of RSS-COX2 score was more than that of Xuanzhong group.Discussions: Since the sample size was too small to make statistics processing, this pre-trial just provided reference to choosing"no-related acupoint"for formal trial by analyzing the trend of effects of acupoints. Although the analgetic effect of electric-acupuncturing on Sanyinjiao was relatively better than that of Xuanzhong by analyzing the trend of effect evaluation indexes (VAS and RSS-COX2), large spacement trial are needed. |
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