Observation on the Effect of Acupoint Injection plus Massage Therapy on Primary Dysmenorrhea

1 The Second People’s Hospital of Zhanhua County, Shandong 256803, China

2 People’s Hospital of Binzhou Municipality, Shandong 256610, China

CLINICAL STUDY

Observation on the Effect of Acupoint Injection plus Massage Therapy on Primary Dysmenorrhea

Lü Li-xia, Lü Meng, Fan Yi-wen

1 The Second People’s Hospital of Zhanhua County, Shandong 256803, China

2 People’s Hospital of Binzhou Municipality, Shandong 256610, China

Author: Lü Li-xia, bachelor, attending physician.

E-mail: 624227998@qq.com

Objective: To observe the clinical effects of acupoint injection therapy plus massage on primary dysmenorrhea (PD).

Methods: Ninety patients with PD were randomly divided into a treatment group or a control group, 45 cases in each group. The treatment group was treated by injection of Vitamin K3into Sanyinjiao (SP 6) plus massage on Diji (SP 8). The control group was treated by oral administration of Ibuprofen sustained-release capsule. Before and after the treatment, visual analogue scale (VAS) was adopted to assess pain degree of the patients. The therapeutic effects were observed after continuous treatment of three cycles of menstruation.

Results: After treatment, VAS scores were obviously decreased in both groups and the differences were statistically significant (allP＜0.05). The difference in VAS score after treatment was more significant in the treatment group than that in the control group (P＜0.01). The total effective rate was significant higher in the treatment group than that in the control group (P＜0.05).

Conclusion: Acupoint injection therapy plus massage for PD is effective and better than simple oral administration of Ibuprofen sustained-release capsule.

Hydro-acupuncture Therapy; Tuina; Massage; Dysmenorrhea; Visual Analogue Scale; Point, Sanyinjiao (SP 6); Point, Diji (SP 8); Medicine, Chinese Traditional

Primary dysmenorrhea (PD), also termed functional dysmenorrhea, is one of the commonly encountered gynecological diseases. It refers to intolerable pain in the lower abdomen and lumbar region during, before or after menstruation in women that affects work and daily life. The occurrence rate of PD is 33.1% in China, including 53.2% of primary condition, and in 13.6% of the affected, dysmenorrhea severely influences their work[1-2]. Therefore, the prompt and effective analgesia is very significant in the treatment of dysmenorrhea[2].

We have treated 45 patients with PD by injecting Vitamin K3into Sanyinjiao (SP 6) plus massage on Diji (SP 8) according to the meridian theory of traditional Chinese medicine (TCM), in comparison of the therapeutic effects of oral administration of Western medication. Now, the report is given as follows.

1 Clinical Materials

1.1 Diagnostic criteria

The diagnostic criteria were stipulated in accordance with theObstetrics and Gynecology[3]and the Criteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[4]: distending pain in the lower abdomen during menstruation, without organic pelvic diseases.

1.2 Inclusion criteria

Those in conformity with the diagnostic criteria of PD, agreed and signed the informed consent.

1.3 Exclusion criteria

Those with fever and severe infection; those with dysmenorrhea caused by pelvic inflammatory diseases, ectopic endometriosis, uterine tumor confirmed by examinations, accompanied by severe diseases in the cardiovascular, hepatic, renal and hematopoietic systems; and those with mental disorders and not suitable for this therapy.

1.4 Statistical methods

Statistical analysis was processed by the SPSS 13.0 version statistical software. The measurement data were expressed by using mean ± standard deviationThe counting data were processed by Chisquare test.P＜0.05 indicated the statistic significance in the difference.

1.5 General data

Totally, 90 patients with PD were enrolled from the gynecology clinic of our hospital from January of 2011 to September of 2012. The age of the patients ranged from 14-26 years old, at the average age of (19±1.4) years old, and the duration ranged from 6 months to 5 years. By their visit order, the patients were randomly divided into a treatment group or a control group, 45 cases in each group. In comparison of the age, duration and visual analogue scale (VAS) score of pain before the treatment, the differences were not statistically significant (allP＞0.05), indicating that the two groups were comparable (Table 1).

Table 1. Comparison of general data between the two groups

Table 1. Comparison of general data between the two groups

2 Therapeutic Methods

2.1 Treatment group

Acupoints: Bilateral Sanyinjiao (SP 6), Diji (SP 8).

Operation: After the patient took a supine position, 2 mL disposable sterile syringe was used to draw 8 mg of Vitamin K3[5]. After the skin of Sanyinjiao (SP 6) was cleaned routinely, the needle was quickly inserted into the acupoint and after the patient had the sore, numb or distending sensation and after no backflow of blood, 4 mg of injection was slowly injected into the acupoint. While the needle was removed, the needle hole was pressed, and then the acupoint at the opposite sited was injected. After the acupoint injection, bilateral Diji (SP 8) are pressed and kneaded by the thumb, with stimulation of moderate force, by even, gentle and penetrating force, till the patient had obvious sore and distending sensation, for 10 min.

The treatment was given once when dysmenorrhea occurred on the first day of menstruation, continuously for three menstrual cycles.

2.2 Control group

Ibuprofen sustained-release capsule (Tianjin Smith Kline & French Pharmaceutical Co., Ltd., Approval number: GYZZH10900089), 0.3 g each pill, one pill taken orally after meal during menstruation, twice a day, continuously for 5 d, for three menstrual cycles successively.

3 Therapeutic Effects

3.1 Observed index

VAS score was used to assess pain severity of the patients[2]. VAS is an international scale to describe pain degree, i.e. drawing a 10 cm linear scale as a staff gauge to measure pain, and the starting part is labeled with 0 point, representing no pain, and the end part is labeled 10 points, representing intolerable pain. Before and after the treatment, the patients marked on the staff gauge respectively to reflect pain degree. VAS score was obtained from the measuring mark on the staff gauge.

3.2 Criteria of therapeutic effects

Based upon the criteria of the therapeutic effects on dysmenorrhea in theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[4].

Cure: Pain disappeared, no recurrence in three menstrual cycles after the treatment was stopped.

Improvement: Pain was relieved or disappeared, but unable to remain for three menstrual cycles.

Failure: No relief of pain after the treatment.

3.3 Therapeutic results

3.3.1 Comparison of VAS scores before and after the treatment between the two groups

After the treatments, VAS scores in the two groups were decreased than those of the same groups beforethe treatment, and the differences within the groups were statistically significant (allP＜0.05). After treatment, VAS score was obviously lower in the treatment group than that in the control group (P＜0.01), and the difference of VAS score after treatment was more significant in the treatment group than that in the control group (P＜0.01), (Table 2).

3.3.2 Comparison of clinical effects between the two groups

The total effective rate was 95.6% in the treatment group and 77.8% in the control group, and the difference between the two groups was statistically significant (P＜0.05), (Table 3).

Table 2. Comparison of VAS scores (, point)

Table 2. Comparison of VAS scores (, point)

Note: Compared with the same group before the treatment, 1) P＜0.05; compared with the control group, 2) P＜0.01, 3) P＜0.01

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Table 3. Comparison of clinical effects between the two groups (case)

4 Discussion

PD belongs to the scope of menstrual pain in traditional Chinese medicine. Its pathological position is in the uterus, the Thoroughfare Vessel and the Conception Vessel, and its pathogenesis includes pain due to blockage and malnourishment[6-8]. It is believed in gynecology of Western medicine that PD occurs as a result of increase of prostaglandin (PG) content in the endometrial tissues and blood during menstruation[2,9]. PG induces and stimulates the excessive contraction of the smooth muscle of the uterus, and uterine ischemia is the main factor to cause dysmenorrhea. Acupuncture, acupoint injection therapy and massage are the common effective methods for dysmenorrhea. In the previous reports, the treatment was mostly given during the non-painful period[2]. The prompt relief of pain is the need of the patients, and the humanistic intervention can enhance the life quality of the patients.

Acupoint injection is a therapy of acupuncture and medication[10]. By pharmacological action of medications and opening, closing and propagation of the acupoints, their integrated effect can produce strong stimulation to the human body, quickly excite meridian qi, dredge meridians and collaterals, regulate Zang-fu organs and obviously enhance the drug effect, so as to cure the disease[10]. Vitamin K3has the effects to stop bleeding and pain. It has been proven in the latest study that Vitamin K3not only can inhibit the secretion of gastric acid, protect the gastric mucosa, promote healing of ulcers, but also can stop pain and antagonize the powerful contractile effect of prostaglandins on the smooth muscle of the uterus[11-12]. Sanyinjiao (SP 6) is a crossing acupoint of the Meridians of Foot Taiyin, Foot Jueyin and Foot Shaoyin. Three yin meridians of foot link with the Conception Vessel, and the Thoroughfare Vessel goes parallel with the Kidney Meridian of Foot Shaoyin in the abdomen. Therefore, Sanyinjiao (SP 6) communicates with the Conception Vessel via the three yin meridians of foot and also communicates with the uterus via the Thoroughfare Vessel and Conception Vessel. The Thoroughfare Vessel is the sea of blood and Conception Vessel is the sea of yin meridians, and they can jointly regulate qi and blood in the uterus. Acupuncture at Sanyinjiao (SP 6) can strengthen the stomach and spleen, assist digestion, regulate and reinforce the liver and kidney, dredge the meridians and collaterals, regulate and harmonize qi and blood, so as to regulate the functions of the liver, spleen and kidney and realize the analgesic effect. The injection of Vitamin K3into Sanyinjiao (SP 6) not only can intensify the needling sensation, enhance the regulatory action of the acupoint on the organism, but also can realize the effect to stop pain in a short period of time because of the joint cooperation of acupoint, meridians and medication.

Diji (SP 8), the Xi-Cleft acupoint of the Spleen Meridian of Foot Taiyin, can strengthen the spleen and stomach, regulate menstruation, and is also an important acupoint in the treatment of dysmenorrhea. The Xi-Cleft acupoints are located at where meridian qi and blood gather in the deep area, can dredge qi and blood and regulate the functions of Zang-fu organs and are often used to treat acute conditions on the pathway of the meridian and Zang-fu organs. Xi-Cleft acupoints of yin meridians are also majorly used for bleeding conditions[2,9]. Dysmenorrhea attack is an acute pain and also belongs to bleedingcondition. condition. Therefore, the Xi-Cleft acupoint of the Spleen Meridian is selected to dredge qi of Spleen Meridian for stopping pain. The spleen and stomach are the post-natal foundation and resources for production of qi and blood. The spleen dominates transportation and transformation and governs blood and plays an important role in the transportation and transformation of qi and blood. The occurrence of dysmenorrhea is closely related to the spleen and stomach. The selection of Diji (SP 8) from the Spleen Meridian is in conformity with the theory on meridian attribution[6].

In summary, the injection of Vitamin K3into the acupoint, with the effect of acupuncture and medication, plus massage on Diji (SP 8), can quickly excite meridian qi, dredge meridians, activate blood, and regulate functions of the liver, spleen and kidney by dredging three yin meridians of foot for regulating qi and blood of the uterus indirectly, so as to smoothen the Thoroughfare Vessel and Conception Vessel, and promote the circulation of blood in the uterus, and to obtain the remarkable analgesic effect in a short period of time. It has been proven by this study that acupoint injection therapy plus massage for PD can effectively decrease VAS scores of the patients, has more significant and efficient analgesic effect and also is simple in operation and free of side effect. Therefore, this therapy needs to be popularized in clinic.

Conflict of Interest

The authors declared that there was no potential conflict of interest in this article.

Acknowledgments

This work was supported by the Second People’s Hospital of Zhanhua County, Shandong Province and People’s Hospital of Binzhou Municipality, Shandong Province.

Statement of Informed Consent

All of the patients in the study signed the informed consent.

[1] Qiu T. The pathogenesis and new progress of therapy on primary dysmenorrhea. Jixu Yixue Jiaoyu, 2005, 19(3): 60-61.

[2] Li WJ, Zhao C. Clinical observation on acupuncture treatment with Xi-Cleft acupoint Diji (SP 8) for primary dysmenorrheal. Shanghai Zhenjiu Zazhi, 2011, 30(12): 817-818.

[3] Le J. Obstetrics and Gynecology. 7th Edition. Beijing: People’s Medical Publishing House, 2008: 318.

[4] State Administration of Traditional Chinese Medicine. Criteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine. Nanjing: Nanjing University Press, 1994: 61-62.

[5] Yang YH. Treatment of 52 cases of primary dysmenorrhea by acupoint injection therapy plus external application of moxibustion. Zhongguo Zhongyi Jizheng, 2011, 20(11): 1876.

[6] Li WJ, Wang AD, Cao XW, Chen J, Zhao C. Feature study on abdominal thermal infrared image in the treatment of dysmenorrheal by moxibustion at Diji (SP 8). Shanghai Zhenjiu Zazhi, 2012, 31(9): 659-661.

[7] Wu YY, Wang P, Zhao JP. Exploration on acupuncture treatment of dysmenorrhea. Beijing Zhongyiyao, 2009, 28(4): 279-280.

[8] Cao Y, Zhao L, Zhang TT, Xu LW, Lian WQ, Yan PQ, Xu M, Chen Q. Clinical observation on Chinese herbs in treating 139 cases with dysmenorrhea based on syndrome differentiation. Zhongyi Zazhi, 2013, 54(6): 488-491.

[9] An Y, Du DQ, Gao SZ, Ma YX. Clinical study on different intervention times of acupuncture for primary dysmenorrhea. Shanghai Zhenjiu Zazhi, 2013, 32(2): 91-93.

[10] Li B, Fan YW, Shen YL. Clinical observation on comprehensive therapy of acupoint injection therapy plus enema for postpartum urinary retention. Yixue Chuangxin Yanjiu, 2006, 3(5): 16-17.

[11] Lu JX, Lu WB, Ke ZM. Observation of clinical effect of treatment of primary dysmenorrhea by injecting Vitamin K3into Sanyinjiao (SP 6). Zhejiang Zhongxiyi Jiehe Zazhi, 2011, 21(2): 103-104.

[12] Yu J, Wang L, Zhao WJ, Francescl Cardini, Laura Regalia. Treatment of 39 cases of primary dysmenorrhea by acupoint injection of Vitamin K3. Zhongguo Zhongxiyi Jiehe Zazhi, 2007, 27(11): 979.

Translator: Huang Guo-qi

R245.9

: A

Date: March 12, 2014