| ObjectivePrimary Dysmenorrhea(PD)is a very common gynecological disease in Malaysian women.Acupuncture therapy has significant clinical advantages in the treatment of PD,but there are a variety of acupuncture treatment techniques,each with its own advantages.Combined with the specific clinical practice,the author found that the effect of blade acupuncture on PD is more significant than that of traditional acupuncture.Therefore,this study firstly used literature review method to comprehensively and systematically summarize the understanding of PD in traditional Chinese medicine in ancient and modern literatures,explain the origin and mechanism of blade needle,and compare and analyze the similarities and differences between needle knife,beryllium needle and blade needle.Then,according to the concept and method of evidence-based medicine,mesh meta-analysis was used to comprehensively and systematically evaluate the efficacy differences of different acupuncture therapies in the treatment of PD.Finally,a rigorous prospective randomized controlled trial was designed to confirm the therapeutic advantage of blade needle hegu acupuncture in the treatment of PD compared with conventional filiform needle acupuncture,providing new scientific evidence for the clinical treatment of PD.MethodsLiterature research:Based on ancient and modern literature,the understanding of PD in TCM was systematically reviewed,including the origin of disease,etiology and pathogenesis,syndrome differentiation and treatment methods,etc.Summarize the understanding of PD in modern medicine;Explain the origin and mechanism of blade needle,compare and analyze the similarities and differences between needle knife,beryllium needle and blade needle.Evidence-based evaluation:China National Knowledge Network(CNKI),VIP,WF,CBM,PubMed,Embase,Cochrane Library and other databases were comprehensively searched.Randomized controlled trials(RCTS)studies on acupuncture therapy for PD were collected by manual retrieval.ROB 2.0 risk bias assessment tool was used for methodological quality assessment and CONSORT items were used for reportological quality assessment.After collecting THE RCT data,the researchers adopted the frequency statistical analysis method,used STATA 16 software for data analysis,and drew various evidence charts.MD or SMD were used as the effect size for continuity variables,RR was used as the effect size for dichotomous variables,and their effect size(95%confidence interval(95%CI))was calculated respectively.Local inconsistencies are investigated by"ring method" or "point method" test.If there is inconsistency,the inconsistency model is used for analysis,and sensitivity analysis is conducted to judge the stability of the results.On the contrary,the consistency model was used to calculate the comparative effect size of each treatment measure to draw the league table.Under different outcome indicators,the"area under cumulative Ranking Curve"(SUCRA)and its percentage values were obtained by ranking all treatment measures.Funnel plots were drawn to measure publication bias or the presence of small sample effects.Clinical study:136 qualified PD patients were included,all from The Chinese Medicine outpatient department of Suntech Medical Malaysia and Wanfutang Medical Bureau.Patients were divided into two groups by random number table method.Experimental group(n=68):Shiqi Zhui,Guan Yuan,Diji and Abdominal Ashi Point(Yi Point)were selected and blade needle Hegu acupuncture was applied.Control group n=68):The above acupoints were selected and ordinary filiform needle was used.Treatment was started 20 days after the onset of menstruation in both groups,and continued for 7 days in each menstrual cycle.One menstrual cycle is 1 course of treatment,continuous treatment for 3 courses.The observation indexes were COX Dysmenorrhea Symptom Scale(CMSS),PRIMARY dysmenorrhea TCM symptom score and pain visual analog scale(VAS).The efficacy criteria were evaluated according to the Technical Guidelines for Clinical Research of Syndromic Traditional Chinese Medicine New Drugs issued by sFDA in 2018 and combined with the score of primary dysmenorrhea symptoms.Statistical analysis was performed using SPSS 23.0 statistical software.ResultsLiterature part:It was found that blade needle Hegu acupuncture originated from Neijing,which,like acupotomy and beryllium needle,belongs to the micro wound of TRADITIONAL Chinese medicine.It has the characteristics and advantages of large amount of stimulation,penetrating several points with one needle,focusing on points and acting on the tendons,and is very suitable for the treatment of PD and other painful diseases.Evidence-based part:119 literatures and 8706 patients were included.There were 111 two-arm studies and 8 three-arm studies,involving 13 single acupuncture interventions and 5 combined acupuncture interventions.The overall risk of bias was found in the included studies,including 9 high-risk studies(8.03%),90 possible studies(88.24%),and 13 low-risk studies(11.76%).Some studies omitted the description of allocation hiding and blinding.Mesh meta-analysis showed that:1)Improving efficiency:Compared with acupuncture,electroacupuncture MD=15.27,95%CI(2.06.113.48),fire acupuncture MD=6.43,95%CI(1.11,37.16),warm acupuncture MD=23.76,95%CI(1.40,404.25),thunder fire moxibustion MD=6.85,95%CI(1.33,35.22)showed better efficacy.Compared with western medicine,MD=5.73,95%CI(1.02,32.04),MD=4.98,95%CI(1.35,18.37),MD=3.35,95%CI(1.04,10.78),MD=15.78,95%CI(2.32,107.17),MD=15.78,95%CI(2.32,107.17),MD=10.27,95%CI(1.01,104.25)were better for warm moxibustion.The sorting result is:Warm moxibustion(84.4%)>electric moxibustion(81.4%)>Tu-tu-moxibustion(74.6%)>Separation moxibustion(71.7%)>light-fire moxibustion(66.7%)>fire moxibustion(63.5%)>heat-sensitive moxibustion combined with acupuncture(61.0)%)>moxibustion combined with warm moxibustion(60.1%)>acupoint embedding combined with moxibustion(57.2%)>ear sticking(54.9%)>acupuncture combined with moxibustion(48.4%)>moxibustion combined with ginger moxibustion(45.9%)>acupuncture combined with ginger moxibustion(44.8%)>acupoint embedding(34.0%)>ginger moxibustion(31.2%)>point application(26.6%)>Heat sensitive moxibustion(22.3%)>acupuncture(11.3%)>Western medicine(9.8%).2)Reducing symptom score:Warm moxibustion MD=4.13,95%CI(0.81,7.46),ginger moxibustion MD=4.42,95%CI(0.61,8.24),moxibustion moxibustion MD=3.70,95%CI(0.42.6.99),compared with the governor moxibustion can effectively reduce symptom score.Thermal moxibustion combined acupuncture MD=3.33,95%CI(6.53,0.14),warm acupuncture MD=1.88,95%CI(3.43,0.34),the acupuncture point bury line MD=1.69,95%CI(2.82,0.56),the thunder fire moxibustion MD=0.73.95%CI(-3.93,2.47)was better than filiform acupuncture.Joint acupuncture moxibustion MD=2.38.95%CI(4.16,0.60),the thermal moxibustion combined acupuncture MD =4.92,95%CI(7.98,1.86),the curative MD=2.97.95%CI(4.88,1.07)=3.47,warm acupuncture MD,95%CI(4.95,1.99),jiang jiu the MD=3.76,95%CI(6.21,1.31),insulation effect MD = 3.04.95%CI(4.27,1.81),acupoint sticking MD=2.48,95%CI(3.92,1.05),the acupuncture point bury line MD=3.27,95%CI(4.37,2.18),acupuncture MD=3.27,95%CI(4.37,2.18),the western medicine effect is better.The sorting result is:Acupoint embedding combined with moxibustion(87.4%)>warm moxibustion(75.5%)>intermedicinal moxibustion(66.8%)>interginger moxibustion(66.7%)>heat-sensitive moxibustion combined with acupuncture(63.4%)>electric acupuncture(59.9%)>Acupuncture combined with moxibustion(53.9%)>thunder fire moxibustion(52%)>moxibustion(50.7%)>heat sensitive moxibustion(46.2%)>auricular sticking(43.6%)>acupoint application(42.3%)>acupoint embedding(42%)>acupuncture(39.7%)fire acupuncture(32.4%)>Western medicine(14.3%)>Acupuncture moxibustion(13.1%).3)In terms of VAS score reduction,thunder fire moxibustion was superior to acupuncture MD=-3.78,95%CI(-7.51,-0.04),and was superior to Western medicine MD=-3.31,95%CI(-6.57,-0.05).Sorting results:Thunder and fire moxibustion(89.2%)>separated moxibustion(74.3%)>moxibustion(69.1%)>acupuncture combined moxibustion(68.9)%)>moxibustion combined with warm moxibustion(62.0%)>heat sensitive moxibustion combined with acupuncture(57.3%)fire acupuncture(54.8%)>acupoint embedding(51.6%)>acupoint application(50.0%)>electric acupuncture(49.6%)>warm moxibustion(44.3%)>Tu-tu-moxibustion(42.6%)>auricular sticking(32.6%)>heat sensitive moxibustion(28.8%)>Western medicine(28.8%)>ginger moxibustion(27.5%)>acupuncture(17.8%).Clinical studies1.Reliability q-q plot was used to calculate the comparability of two groups of data.In Normal Q-q plot,COX table before treatment showed Normal distribution,with no statistical difference and comparability.Process the collected data,there were no statistically significant differences in miscarriage/miscarriage history,existing children in birth history,and mean values between the two groups(P=0.06,0.21,0.41,0.32.0.52,0.41,all P>0.05),indicating comparability.By comparing the two groups,this study found that both treatments could improve dysmenorrhea,However,the analgesic effect of the combined therapy intervention group was relatively more ideal,while the analgesic effect of the other group was less,P<0.05.During the follow-up,it was found that the effect continued after the end of the whole course of treatment.2.Scores before and after treatment of primary dysmenorrhea in TRADITIONAL Chinese medicine symptom Degree evaluation Table:Statistical results of t-test of paired samples before treatment and one month after the third treatment in both groups,P<0.05.3.In the score of dysmenorrhea degree,after the whole course of treatment,the effect of the combined intervention group is relatively more significant,,with statistical difference(P<0.05).4.After analysis,it was found that after the intervention,the TCM symptom score of the monotherapy group was significantly different from that before(P<0.05),including lower abdomen pain,unbearable abdominal pain,obvious abdominal pain,restlessness.cold limbs,need to rest in bed,waist pain,nausea and vomiting during menstrual period and before and after the treatment(P<0.05).Therefore,it can be considered that the TCM symptom score of primary dysmenorrhea has a certain effect on the immediate pain relief treatment of acute primary dysmenorrhea.5.Cox score results:after one course of treatment,it can be seen that the score of the patient group receiving combined treatment decreased significantly,while the decline of the other group was not very obvious.However,after the end of the whole course of treatment,through follow-up,it was found that the scores of all patients decreased,but on the whole,while the scores of the other group were relatively higher,which means that combined therapy is more ideal and has higher clinical value,which can be popularized in practice.6.Comparison of vas between the two groups:different methods were used for intervention.It can be seen that the scores of the two groups decreased in each stage.On the whole,the decline range of the combined therapy intervention group was significantly greater than that of the other group,and it was still decreasing for a period of time after the end of the whole course of treatment;In comparison,the radian decreased less and the drug persistence was weaker in the single treatment group.This also means that combination therapy is more effective,especially in effectively reducing pain.7.Mean value of VAS pain score in different time periods:after processing the collected data,it was found that the combined treatment group was 3.529 ±0.813;The value of this parameter in the other group was 1.029±1.602.This means that the former method is helpful to improve primary dysmenorrhea,so it has greater clinical significance and can be used in a wide range.ConclusionThis paper uses the method of comparison between groups to carry out the research,that is,the patients are ’divided into treatment group and control group.After the statistics of the obtained data,it is found that the two methods can play the role of disease control,and the patients’ diseases have been controlled to varying degrees in a period of time after the end of the whole course of treatment.One month after the third treatment,it showed that among the patients treated with combination therapy,6 cases were completely controlled,34 cases were significantly effective,24 cases were effective;In the patient group treated with monotherapy,markedly effective in 8 cases,effective in 35 cases,and the condition was not improved and deteriorated in 25 cases,with a total efficiency of 63.24%.It can be seen that both treatments can alleviate the disease,but the combination therapy is more lasting and the effect is ideal. |
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