A standardized acupuncture point treatment protocol for the management and treatment of primary dysmenorrhea pain, using a multi-point combination

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Title:	A standardized acupuncture point treatment protocol for the management and treatment of primary dysmenorrhea pain, using a multi-point combination A standardized acupuncture point treatment protocol for the management and treatment of primary dysmenorrhea pain, using a multi-point combination
Authors:	Cameron Hall
Contributors:	國際針灸碩士學位學程
Keywords:	針灸;原發性痛經;替代醫學;Acupuncture;Primary Dysmenorrhea;Complementary Medicine
Date:	2018-07-20
Issue Date:	2018-12-25 10:07:03 (UTC+8)
Publisher:	中國醫藥大學
Abstract:	目的：針對原發性痛經（primary dysmenorrhea, PD）和相關症狀的處理的針灸穴位選擇已具有廣泛臨床經驗，其抉擇多數基於中國醫學傳統和/或各學派的理論運用。已有大量的相關臨床試驗（clinical trial, CT）研究發表在各醫學期刊上，其大多數針對PD患者疼痛與相關症狀的針灸治療有效性進行評估。從臨床研究中可見，已發表的論文不僅評估了治療的有效性，發表之論文也指出單一針灸穴位、經脈及配穴之偏好，強調循證醫學之重要性。此文獻研究之目的為擷取文獻中直接針對單一、多重穴位及配穴相關之臨床發現，以提出並設置標準化之針灸穴位治療法，使其成為有效的治療PD疼痛及其相關症狀之基礎。方法: 從三個資料庫 (PubMed, Cochrane, China Academic Journal) 中篩選出八十一份關於以針灸治療PD疼痛和相關症狀之CT文獻。匯集文獻之PD患者為8403名，其針灸治療為五十二穴位寄附於十四經之十一條經脈。並計算單穴位、配穴及三點穴位之使用頻率及其歸屬之經絡。另外，此文獻研究也統整使用視覺疼痛量表 (visual analog scale, VAS) 作為治療後評估工具之論文並製作針灸穴位評估分析圖表，以查看選穴是否存在優先順序。此研究的測量結果包括探討文獻使用傳統中醫理論（traditional Chinese medicine, TCM）作為其針灸選位基礎之比例，並整合所有研究文獻所涵蓋之總時間或總月經週期。結果: 在81篇論文中主要施術的經絡分別為足太陰脾經（72.83％），其次為任脈，足陽明胃經，足太陽膀胱和足厥陰肝經。最常用的穴位是三陰交（66.66％），其次為關元穴。這兩個穴位也是最常用的配對穴，占（32.09％），其次是三陰交配太?}以及關元配氣海。其他個別的穴位分別是太?}，氣海，地機，足三里和血海。最常用的三個穴位組合是三陰交 + 關元 +氣海（19.75％）。在VAS圖表中，最顯著的穴位還是三陰交（70.27％），然而從我們的圖表中可以看出，地機穴和太?}穴先有改變。論文中有39.50％採用了證型診斷，其中50.61％進行了3個月經週期以上。在佔總數44.44％的VAS論文圖表中，75.00％的論文中沒有使用TCM診斷方式。我們所提出的配穴組合是將我們對這81篇臨床試驗論文的廣泛評論所得結果中的所有相關數據進行組合分析後，對原發性痛經和相關症狀的管理和治療選擇針灸穴位的標準化方法的結果。結論：深入探討81份CT研究論文後，我們建議使用多重針灸穴位組合法作為治療PD及PD疼痛管理之基礎，來刺激最重要且相關經脈上之常用的傳統穴位。我們推薦並建議讀者的結論認為實證證實的針灸治療，比單一穴位與配穴針灸治療結果或單純經脈選穴之統計結果更附有重要性。因此提出之多重穴位基礎治療模式能使得在臨床應用中更具有適用性。此針灸治療基礎建議可與中醫辨證一同進行，亦能單獨使用成為針灸治療處方，也因此說明其治療方案用於PD疼痛及其相關症狀之臨床治療中可成為標準化之多重穴位治療法。 Background: The selection of acupuncture points in the management and treatment of primary dysmenorrhea (PD) pain and associated symptoms is often based on traditional theories and/or reputation owing to extensive clinical experience. Numerous papers from clinical trials (CTs) incorporating acupuncture points for PD have been published in respective journals, most been dedicated to the acupuncture treatment evaluation for its effectiveness of relieving pain and secondary symptoms in PD patients. From these clinical studies, review papers have been published not only evaluating the effectiveness of treatment but also studies which indicate the preferences of singular acupuncture points, channel preferences and point pairing combinations which allude to under the models of evidence-based medicine the importance of the aforementioned when employing acupuncture point stimulus for the management and treatment of PD. The research review we set out to achieve was to extract findings from available published papers in direct relation to channel, single point and point pairing preferences to propose a multi-point combination for a standardized acupuncture point subscription protocol to be employed in the clinical setting as a foundation method in the approach for the management and treatment of PD pain and its associated symptoms when employing acupuncture point simuls as the treatment model. Methods: A total of 81 published CT studies extracted from 3 data bases (PubMed, Cochrane, China Academic Journal) for the management and treatment of PD pain and secondary symptoms by the use of acupuncture point stimulation were reviewed. Accounting for a total of 8426 PD patients, 52 individual acupuncture points were employed and sourced from 11 of the 14 main channels used in acupuncture point stimulation treatment. We calculated the frequency of use for individual points, point pairings, 3-point combinations and the channels from which the points originate, in all 81 papers. Furthermore, a separate acupuncture point evaluation chart was created based on the papers which had used Visual Analog Scale (VAS) as their primary tool for outcome evaluation of which was 44.44%, to see if there was a difference in point selection priorities as VAS is an outcome measurement tool for pain evaluation specifically. Measurements of our study also included noting the percentage of papers using Traditional Chinese Medicine (TCM) pattern identification as their basis for acupuncture point selection, as well we noted the time frame of all studies in relation to the number of menstrual cycles the study was conducted over in total. Results: The most predominantly employed channel from the 81 papers was Spleen TaiYin at 72.83% followed by, Conception Vessel Ren Mai, Stomach YangMing, Bladder TaiYang and Liver JueYin respectively. The most used point was SP6 at 66.66%, REN4 GuanYuan was second. These two points were as well the most used 2point pairing accounting for 32.09% followed by SP6+LIV3 and Ren4+Ren6. Other prominent individual points were LIV3, REN6, SP8, ST36 and SP10 respectively. The most employed 3point combination was SP6+REN4+REN6 at 19.75%. Within the VAS chart the most prominent point again was SP6 at 70.27% however a change in priority is seen from our charts with respect to few points most notably SP8 and LIV3. A total of 39.50% of the papers used TCM pattern identification in their acupuncture point subscription and 50.61% of them were conducted over 3 menstrual cycles or more. Within the VAS papers chart which accounts for 44.44% in all, 75.00% of these papers did not include a TCM pattern identification. Conclusion: Our multi acupuncture point combination is proposed as a model from which to approach the treatment and management of PD pain and its related symptoms, using methods that stimulate the most commonly used traditional acupuncture points on the most significant and relevant channels after the extensive reviewing of 81 published CT research papers. This outcome we promote and suggest is of a greater importance to the prospective readers of evidence-based acupuncture, more so than a singular point or point pairing outcome hypothesis or a channel specific statistical outcome alone. This makes for a more clinically applicable treatment modality with respect to its specific purpose as a proposed foundation model in the application of a multiple acupuncture point stimulus prescription to be used within the clinical setting. We propose that our result be used with or without the inclusion of an individualized TCM pattern differentiation or its treatment principles thus accounting for a treatment protocol that is a standardized multi-point model for clinical application in the management and treatment of PD pain and its associated symptoms.
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