Clinical Research In Treating Primary Dysmenorrhea Of Coldness And Dampness Stagnation Type By Warm Acupuncture Together With Chinese Herbal Medicine In Different Intervention Time.

Objective:1.To investigate the analgesic effectiveness of warm acupuncture with Chinese herbal granule on coldness and dampness stagnation type dysmenorrhea patients in different warm acupuncture intervention times by launching a randomize controlled-trial.It evaluates the best warm acupuncture intervention time.2.To compare the difference of therapeutic effect between warm acupuncture group and Chinese herbal granules group in order to figure out the high effective treatment for coldness and dampness stagnation type dysmenorrhea patients.Methods:130samples of coldness and dampness stagnation type of primary dysmenorrhea patients were selected and randomly divided into 4 groups in 1:1:1:1 ratio:5 days prior treatment group(Treatment group A)32samples,3 days prior treatment group(Treatment group B)32samples,first menstrual day treatment group(Treatment group C)33samples,and control group(Chinese herbal granules group D)33samples.Treatment group A:Patients started the warm acupuncture 5 days prior to the menstruation and the treatment was performed in once a day and in 5 continuous days..The whole treatment was performed within 3 consecutive menstrual months.The acupuncture needles were disposable sterile stainless steel needles of 0.25*40mm.The acupoint prescription were as follow:Zhong ji,Guan Yuan,Di ji(double side)Shui Dao(double side)Gui Lai(double side).Mr.Chen's Fly needle was performed during the insertion of acupuncture needle.Di ji,Shui Dao,Gui Lai were performed in huge reducing method.The remaining acupoint were performed in moderate enforcing and reducing method.Then the practitioner insert a 2cm moxibustion stick on every needle head.Put a 6cm2 hard paper card with a cut line on the warm acupoint in order to prevent skin burn.When the moxibustion stick was fully burned,the practitioner removed it and the treatment was finished.The whole treatment time was approximately 20 minutes.Patients were informed to take Chinese herbal granules(Shaofuzuyu concoction plus fuling and cang shu).The indication to take herbal granules(Shaofuzuyu concoction plus fuling and cang shu)5 days prior to the menstruation and continuously took it till the third day of menstruation.Patients were informed to take the granules once a day,and in 3 continuous menstrual months.The indication is to dissolve the herbal granules into 200ml hot water and drink it when it become warm.Treatment group B:Patients started the warm acupuncture 3 days prior to the menstruation and the treatment was performed once a day and in 5 continuous days(treatment ended in the third day of menstruation).The acupoint and treatment method is the same as acupuncture treatment group A.The prescription and indication of Chinese herbal granules were the same as treatment group A.Treatment group C:Patients started the warm acupuncture right at the first day of menstruation and the treatment was performed once a day.and in 5 continuous days(treatment ended in the sixth day of menstruation).The prescription and indication of Chinese herbal granules were the same as treatment group A.Treatment group D:The prescription and indication of Chinese herbal granules were the same as treatment group A.Patients in 4 groups were requested to fill in these 2 score lists before treatment,in 1st,2nd and 3rd month of treatment,and the sixth months of treatment(follow up).NRS numeric rating scale dysmenorrhea symptoms score list and CMSS dysmenorrhea score scale were adopted to evaluate the results.Data was collected to objectively investigate the effectiveness of warm acupuncture performed in different intervention time and the duration of the effectiveness.Results:There were 2samples quitting in group A and B,3 samples qutting in group C and D.As a result the total number of samples under investigation were 120(group A:30,group B:30,group C:30,group D:30)(1)By comparing data of the age,disease duration,NRS numeric rating score,the frequency and intensity of CMSS dysmenorrhea symptoms(before treatment)among 4 groups,there are no statistical difference(P>0.05).(2)To analyse NRS numeric rating score of before treatment period,treatment in 1st month,treatment in 2nd month and treatment in 3rd month among 4 groups,the result of 4 groups are statistically different,which indicates there are significant pain reduction after treatment within 4 groups.(3)The total therapeutic rate of NRS score in treatment group A,2,3 and control group are 96.67%,93.330%,90.00%and 76.670%respectively?By Kruskal-Wallis H analysis,the difference between the total therapeutic rate among 4 groups is statistically significant.(P<0.01)?(4)To compare the CMSS dysmenorrhea symptoms frequency score,there are no statistical differences between treatment group A and B,(P>0.05).However,the CMSS dysmenorrhea symptoms frequency scores in treatment group A and C,treatment group A and D,treatment group B and C,treatment group B and D,treatment group C and D are significantly reduced compared with control group(P<0.05).This implies that warm acupuncture together with Chinese herbal medicine has better effectiveness to shorten the frequency of dysmenorrhea symptoms than solo Chinese herbal medicine.It also indicates the 5 days and 3 days prior warm acupuncture has better effectiveness to shorten the frequency of dysmenorrhea symptoms than warm acupuncture which starts at the first menstrual day.(5)To compare the CMSS dysmenorrhea symptoms intensity score,there are no statistical differences between treatment group A and B,(P>0.05).However,the CMSS dysmenorrhea symptoms frequency scores in treatment group A and C,treatment group A and D,treatment group B and C,treatment group B and D,treatment C and D are significantly reduced compared with control group(P<0.05).This implies that warm acupuncture together with Chinese herbal medicine has better effectiveness to shorten the frequency of dysmenorrhea symptoms than solo Chinese herbal medicine.It also indicates the 5 days and 3 days prior warm acupuncture has better effectiveness to relieve the dysmenorrhea symptoms intensity than warm acupuncture which starts at the first menstrual day.(6)To compare the long term effectiveness in shortening the frequency of dysmenorrhea symptoms,there is significant difference between treatment group A and B,treatment group A and C,treatment group A and D,treatment group B and C,treatment group B and D,and treatment group C and D(P<0.05).This implies that warm acupuncture together with Chinese herbal medicine has better effectiveness to shorten the frequency of dysmenorrhea symptoms in long term than solo Chinese herbal medicine.This indicates that 5days prior warm acupuncture has better effectivenss to shorten the frequency of dysmenorrhea symptoms in long term than 3 days prior warm acupuncture,while 3 days prior warm acupuncture has better effectivenss to shorten the frequency of dysmenorrhea symptoms in long term than warm acupuncture which started at the first menstrual day.It shows that earlier warm acupuncture intervention will result in better long term effectiveness in shortening the frequency of dysmenorrhea symptoms.(7)To compare the long term effectiveness in relieve the intensity of dysmenorrhea symptoms,there is significant difference between treatment group A and C,treatment group A and D,treatment group B and C,treatment group B and D and treatment group C and D(P<0.05).However,there is not significant difference between treatment group A and B(P>0.05).This implies that warm acupuncture together with Chinese herbal medicine has better effectiveness to shorten the frequency of dysmenorrhea symptoms in long term than solo Chinese herbal medicine.It also indicates the 5 days and 3 days prior warm acupuncture has better effectiveness to relieve the dysmenorrhea symptoms intensity in long term than warm acupuncture which starts at the first menstrual day.Conclusion(1)Chinese herbal treatment and warm acupuncture with Chinese herbal treatment are proven to reduce the dysmenorrhea pain frequency and intensity significantly.Chinese herbal treatment and warm acupuncture have complementary effect,which has better therapeutic effect than solo Chinese herbal treatment.(2)There is a significant difference between 5 days prior warm acupuncture and 3 days prior warm acupuncture in the reduction of the frequency of dysmenorrhea symptoms in long-term.There is a significant difference between 3 days prior warm acupuncture and warm acupuncture which starts at the first menstrual day,in the reduction of the intensity of dysmenorrhea symptoms.It is concluded that establishing earlier intervention of warm acupuncture will result in better effectiveness in shortening the pain period in treating coldness and dampness stagnation type of primary dysmenorrhea patients.