Primary pain is often seen in adolescent women, more often several years after menarche, and is characterized by a high incidence and recurrence rate. Especially with the acceleration of the pace of life, the increase of work, employment and other pressures, the incidence of primary dysmenorrhea is increasing year by year. Therefore, how to effectively prevent and treat primary dysmenorrhea and improve the quality of life of women is of great clinical significance.
Traditional Chinese medicine has a different mechanism for treating primary dysmenorrhea and Western medicine, Western medicine is mainly to relieve pain, but long-term use of contraceptives, painkillers is easy to produce dependence, increasing the risk of toxic side reactions. Traditional Chinese medicine starts from dialectical treatment to achieve the purpose of treating both the symptoms and the root causes. There are many clinical methods of treating primary dysmenorrhea in clinical traditional Chinese medicine, and how to choose effective treatment methods and reduce the incidence of dysmenorrhea is one of the hot spots in current clinical research.
In this article, the etiology, pathogenesis, treatment principles and TCM treatment methods of primary dysmenorrhea are reviewed below, in order to provide a new therapeutic direction for the treatment of primary dysmenorrhea by TCM.
Etiology of primary dysmenorrhea
The pathogenesis of primary dysmenorrhea is more complex, and its mechanism is not yet fully clear, mainly believed that "if it is not common, it is pain, and if it is not honorable, it is pain", and its incidence and pain degree are closely related to the traditional Chinese medicine system. Relevant studies have shown that qi deficiency, blood stasis, qi depression, humid and hot constitution are prone to primary dysmenorrhea. Therefore, loss of life, insufficient endowment, poor mood, long-term illness and physical weakness can lead to the occurrence of primary dysmenorrhea.
Primary dysmenorrhea is located in the uterus and rush, and the internal organs are closely related to the liver, kidney, and spleen. Dysmenorrhea is also divided into false and real, external causes of the invasion of the six evil spirits, living disorders, unruly diet, internal causes of poor mood, qi imbalance, etc., resulting in cold and evil condensation in the meridians, blocking the flow of qi and blood in the Chong Ren and the uterus, and causing dysmenorrhea. Deficiency of qi and blood, insufficient liver and kidney, will cause insufficient qi and blood, loss of nourishment, and eventually cause false dysmenorrhea. Therefore, the empirical evidence is that although it is not true, it causes pain; The false evidence is ischemia, and the loss of nourishment causes pain.
In "Chinese Gynecology", dysmenorrhea is divided into five types: qi stasis, cold coagulation blood stasis, humid heat accumulation, qi and blood weakness, liver and kidney loss, and the clinical symptoms are mainly cold coagulation blood stasis. It can be seen that the differentiation and classification of dysmenorrhea is complicated, but blood stasis caused by qi and blood disorders is the key to primary dysmenorrhea.
Principles of TCM treatment of primary dysmenorrhea
Treatment varies depending on the etiology of clinical dysmenorrhea.
Qing Dynasty scholar Gao Shilu proposed that the use of general application as the basis, the weak to help it, the cold to make it through. That is, there are different methods of dysmenorrhea, and you can choose the method of regulating qi and blood according to individual differences.
Clinically, according to the physiological characteristics of menstrual period of different patients, the "combination of general regulation" method is advocated for the treatment of primary dysmenorrhea. In terms of treatment timing, scholars mostly use the changes of qi, yin and yang in different cycles of menstruation, and combine the etiological characteristics of treatment to achieve good treatment results.
Deng Yun et al. believe that the clinical manifestations of dysmenorrhea syndrome are mostly mixed with false heat, hot and cold, and false standards, and treatment must be based on the cause and specimen, and symptomatic treatment should be given when pain occurs.
Zhang Lan's research also mentioned that the treatment of primary dysmenorrhea should focus on the main cause and supplement it with pain relief. Regardless of the actual situation, the medication time is at least 3~7 days before the start of the disease, if the treatment is too late, a large number of blood stasis has been formed, the disease progresses, and the clinical treatment will be difficult to achieve the expected effect.
In the study of Zhou Qi et al., it is advocated that the syndrome should be identified according to the type of syndrome, for example, patients with cold blood stasis must start treatment 10 days before menstruation, and decide whether to continue treatment through menstrual conditions. Patients with weak blood gas should take Chinese medicine to nourish blood after menstruation.
It can be seen that there are many treatments for primary dysmenorrhea, and there is no unified treatment standard, dialectical standard, and clinical efficacy evaluation standard. Clinical treatment should follow the principle of dialectical treatment and select corresponding adjuvant treatments such as qi, comprehensive, and symptomatic according to the specific conditions of the patient's condition to achieve the treatment goal.
Oral treatment of traditional Chinese medicine and proprietary Chinese medicine
Primary dysmenorrhea is based on differentiation, taking symptomatic as the criterion, and selecting corresponding blood vitalization, cold dispersion, qi and blood nourishment, blood circulation and stasis drugs for treatment.
Wen Jing decoction is a common group for regulating menstruation, and is widely used in the treatment of various gynecological diseases.
In the study of Wang Xiaosong et al., the effect of warm menstrual tonic plus minus ibuprofen sustained-release capsule in the treatment of cold coagulation blood stasis primary dysmenorrhea was observed, and the results showed that the use of warm menstrual tonic plus minus treatment of primary dysmenorrhea has a good effect, which can reduce the clinical symptoms of dysmenorrhea, reduce pain score, and reduce the pain of patients. Wen Jing soup is mainly composed of ginseng, angelica, white peony, cinnamon, Chuanxiong, Sichuan ox knee, etc., taken 3 days before menstruation, with the effect of nourishing blood and dispelling stasis, dispersing cold and warm menstruation. At the same time, studies have shown that warm menstrual decoction can regulate vascular endothelial function, improve local blood circulation in the uterus, relieve tissue hypoxia, and further promote the good therapeutic effect of cold and wet coagulation primary dysmenorrhea. Therefore, dialectical treatment of primary dysmenorrhea is effective and feasible, and it is worthy of clinical application.
In Qiao Huali's study, warm menstrual decoction was used to treat primary dysmenorrhea with blood stasis type, and the results showed that the total effective rate of clinical treatment was as high as 91.21%, and the clinical symptoms and pain were significantly reduced. Therefore, the clinical selection of warm menstrual decoction for the treatment of primary dysmenorrhea of Qi stasis has a good therapeutic effect, and can be used for clinical reference.
Pan Lijuan's study selected the addition and subtraction of less abdominal decoction to treat primary dysmenorrhea, and the results showed that the degree of menstrual pain and accompanying symptoms of patients before and after treatment were significantly reduced, and the total effective rate was 94.23%. This conclusion further confirms that the use of Liqi Huayu decoction and less abdominal stasis decoction in the treatment of primary dysmenorrhea of Qi stasis has a definite effect. The analysis believes that it may be because the decoction of less abdomen and the decoction of Liqi and Huayu have the effects of activating blood circulation and removing stasis, warming menstruation and nourishing blood, which is suitable for Qi stasis type, and can be added or decreased according to specific symptoms to promote the improvement of clinical symptoms.
Zhang Ke et al. used Yuanhu analgesic drops combined with ibuprofen sustained-release capsules for the treatment of primary dysmenorrhea, and the results showed that the symptoms of dysmenorrhea were significantly reduced and the pain score was significantly reduced, which was significantly better than that of ibuprofen sustained-release capsules alone, indicating that the use of proprietary Chinese medicine to treat primary dysmenorrhea can also obtain good therapeutic effects and promote the improvement of clinical symptoms. The analysis believes that the main ingredient of the Yuanhu painkiller pills used is fussozole extract, which has the effects of rationalizing qi, activating blood and relieving pain, and can promote the improvement of dysmenorrhea symptoms.
At the same time, modern pharmacological research shows that proprietary Chinese medicines mainly reduce the release of calcium ions to inhibit spasmodic function, thereby improving dysmenorrhea symptoms.
Chen Dongmei et al. used turmeric warm menstrual granules for the treatment of primary dysmenorrhea, compared with ibuprofen sustained-release capsules, the results showed that the total effective rate of treatment in the observation group was 92.14%, which was higher than that of the control group of 83.56%, and the recurrence rate was 4.30% after 6 months of follow-up, which was lower than 17.43% (P<0.05) in the control group, indicating that proprietary Chinese medicine had good clinical efficacy in the treatment of primary dysmenorrhea and had a low recurrence rate.
The above studies have confirmed that traditional Chinese medicine and proprietary Chinese medicine can achieve certain efficacy in the treatment of primary dysmenorrhea. At the same time, compared with Chinese medicine decoction, proprietary Chinese medicine is easy to carry, simple to take, easy to store, more conducive to the good compliance of clinical patients, can further ensure good therapeutic efficacy, has significant advantages in disease treatment, and is worthy of clinical application.
External treatment of traditional Chinese medicine
4.1 Acupuncture
4.1.1 Acupuncture
Acupuncture for the treatment of primary dysmenorrhea usually adopts differential point selection, combined with uterine position relationship and acupoint neuroanatomical selection.
The acupuncture points selected for acupuncture treatment are mainly Ren pulse and spleen meridian, and most of the above acupuncture points are distributed in the lumbosacral area, abdomen, back and inner side of the lower limbs, which can stimulate the corresponding meridians, promote the smooth flow of qi and blood, and then exert a good therapeutic effect on primary dysmenorrhea. At the same time, acupuncture can avoid adverse reactions of oral drugs and improve the safety of treatment.
Acupuncture alone is more effective than oral therapy, which may be related to stimulation of the human nervous system. However, there are few studies on the long-term efficacy of acupuncture and moxibustion, and there is a lack of clinical large sample confirmation, so the efficacy of acupuncture in the treatment of primary dysmenorrhea can be regarded as one of the important directions of future research.
The study of Liang Manlan et al. showed that the treatment of warm acupuncture combined with flavored warm menstrual decoction and health education intervention in patients with cold and wet coagulation primary dysmenorrhea can improve clinical efficacy, shorten the duration of pain, relieve dysmenorrhea symptoms, reduce the degree of pain, and reduce the incidence of adverse reactions.
In Wang Yi's study, acupuncture plus oligo-abdominal decoction was used orally to treat primary dysmenorrhea, and acupuncture points were selected according to the differentiation classification, and the results showed that the total effective rate of acupuncture combined with oligo-abdominal decoction was 93.20%, which was higher than 81.40% in the control group, and the incidence of adverse reactions was 4.20%, which was lower than 13.56% (P<0.05) in the control group.
This conclusion suggests that acupuncture combined with less abdominal decoction in the treatment of primary dysmenorrhea has a significant effect, and can reduce clinical adverse reactions, which is a feasible and effective treatment plan.
Acupuncture for primary dysmenorrhea can improve blood circulation in uterine cells themselves and promote the recovery of uterine cell function. At the same time, acupuncture directly stimulates the effect, which can unblock the meridians, activate blood circulation and remove stasis, invigorate qi and replenish blood, effectively promote the improvement of primary dysmenorrhea symptoms, and reduce patients' dysmenorrhea. At present, there is controversy and uncertainty about the long-term efficacy of acupuncture alone in the treatment of primary dysmenorrhea. At the same time, acupuncture is mostly used as an auxiliary means in clinical application, and the long-term effectiveness of its solitary application needs to be further explored and confirmed by clinical research.
4.1.2 Moxibustion
In the study of Liang Ruili et al., warm acupuncture was used to treat cold and wet coagulation primary dysmenorrhea, and acupuncture points mainly included hip acupoints and chong ren, and the results showed that the total effective rate of warm acupuncture treatment was 96.12%, which was higher than that of the control group (ibuprofen) by 82.10%, and the pain grade was lower than that of the control group (P<0.05).
It can be seen that warm acupuncture has a significant effect in the treatment of cold and wet coagulation dysmenorrhea, which can reduce the pain of patients. The acupuncture points selected by warm acupuncture have the effect of tonifying kidney qi; Flushing regulates qi and blood, stimulates yang qi, warms the cell palace, and the effect of moxibustion warming, which can reach the deep part of the skin through the needle body, enhance the effect of warm meridian circulation, qi and blood smoothness, and further promote the good effect of cold and wet coagulation type primary dysmenorrhea.
Zhang Xiaoling et al. used moxibustion Shenque acupoint combined with warm acupuncture Guan Yuan and Sanyin Jiao acupoint to treat primary pain, and the results showed that the pain score of the observation group was lower than that of the control group (simple warm acupuncture), and the overall effective rate was higher than that of the control group (P<0.05). Therefore, the use of moxibustion Shenque acupoint combined with warm acupuncture Guan Yuan and Sanyin Jiao Acupoint to treat primary dysmenorrhea has better clinical efficacy than warm acupuncture Guan Yuan and Sanyin Jiao Acupoint alone, and at the same time is safe and reliable, which is worthy of clinical reference. Moxibustion Shenque Acupoint combined with warm acupuncture can combine the advantages of the two and have better efficacy.
Moxibustion umbilicus produces strong penetrating effect and diffusion effect, through the stimulation of nerve endings and the conduction of the nervous system, promote the body to produce local and systemic effects, promote nervous, endocrine, immune, metabolic and other aspects of changes, so as to relieve dysmenorrhea. However, at present, most of the clinical treatments are moxibustion or warm acupuncture simple treatment, and there are few related studies combined with application, and the above research results have certain limitations, and it is necessary to continue to explore the effectiveness and feasibility of moxibustion combined with warm acupuncture in the treatment of primary dysmenorrhea in the future.
4.2 Acupressure point application
Acupressure point application is a kind of external treatment method of traditional Chinese medicine, through water, medicinal juice, honey, etc. to adjust the important secretion to a paste, and then make a medicinal cake, which is applied to the selected acupuncture point to achieve the purpose of treatment. The timing of clinical acupoint application treatment is mostly premenstruation, and the treatment is continued during menstruation, and 5 consecutive cycles of treatment can achieve a certain purpose of relieving menstrual pain.
In the study of Zhao Zhengfang et al., the drugs mainly included Yanhusuo, Chuanxiong, Frankincense, Xiaoxin, and selected Guanyuan, Zhongji, Dahe, Meimen, and Waiyang Guan acupuncture points, and gave treatment before menstruation, and the results showed that the total effective rate of treatment in the observation group was 89.43%, higher than 72.85% in the control group, and the score of dysmenorrhea symptoms was lower than that of the control group (P<0.05).
It can be seen that acupoint application has a good effect in the treatment of primary dysmenorrhea, which is conducive to the relief of clinical symptoms. Dysmenorrhea cream has good analgesic and activating effects, and the drug can directly penetrate into the skin through acupuncture point application, quickly reaching the lesion, delaying the treatment time and exerting a better therapeutic effect. In addition, acupressure application avoids gastrointestinal irritation and is simple to operate, making it recommended as an effective treatment. Therefore, acupressure is also an effective treatment for primary dysmenorrhea.
4.3 Combination therapy
In the study of Jiang Bing et al., warm acupuncture combined with warm menstrual decoction was used to treat primary dysmenorrhea with cold coagulation blood stasis, and the results showed that the treatment effect was significantly better than that of warm menstrual decoction alone, and the symptoms associated with dysmenorrhea could be significantly reduced.
At the same time, He Bing's report showed that after the use of acupoint patch combined with Liqi Huayu decoction for the treatment of primary dysmenorrhea of Qi stasis type, the symptoms of dysmenorrhea in the combined treatment patients were significantly improved, the pain score was significantly reduced, and the level of serum cytoinflammatory factors was low.
It can be seen that combination therapy for primary dysmenorrhea can improve the efficacy and reduce the clinical symptom score of dysmenorrhea. On the basis of Chinese medicine decoction treatment, warm acupuncture or acupoint application can achieve better therapeutic effect; In addition, acupoint application and warm acupuncture can stimulate local acupuncture points, improve blood circulation, promote the operation of blood gas, and then improve clinical efficacy and clinical symptoms.
Wang Bowei et al. treated primary dysmenorrhea through foot bath combined with temperature decoction, and the results confirmed that the treatment effect was significant and could effectively relieve the pain symptoms of patients. This conclusion also further proves that the combination treatment of primary dysmenorrhea can achieve a better therapeutic effect. However, there is no unified standard for specific combination methods, and clinical treatment methods are mainly selected based on the principle of dialectical treatment.
There are many studies related to the combination of the two methods, but whether the effect of the combination of multiple methods is more significant needs to be continuously explored and studied clinically.
4.4 Other therapies
With the continuous clinical research, in addition to the above external methods of traditional Chinese medicine, foot bath therapy, acupoint thread burial method, acupoint injection method, traditional Chinese medicine iontophoresis method, etc. have emerged, and all of them have achieved certain curative effects.
In Yang Yaqin's study, traditional Chinese medicine oral combined with foot bath was used to treat primary dysmenorrhea with cold coagulation blood stasis, and the results showed that after 3 cycles of treatment, the mild rate and total effective rate of dysmenorrhea in the treatment group were higher than those in the control group (P<0.05). The recurrence rate of the treatment group with 3 months of follow-up was significantly lower than that in the control group, suggesting that oral combination of traditional Chinese medicine combined with foot bath treatment could avoid adverse reactions caused by acupuncture and drug treatment, and reduce the symptoms of clinical dysmenorrhea.
Foot bath therapy can be used as an adjunct to the treatment of primary dysmenorrhea, but there are few relevant studies and the efficacy of monotherapy is limited, and further research is needed.
The study of Zhang Huiye et al. used acupoint injection treatment, that is, the injection of danshen injection in the three-negative intersection, compared with oral danshen drop pills, and the results showed that the total effective rate of treatment in the acupoint injection group was higher than that of the oral drug group, and the follow-up was found to have good long-term efficacy.
Acupoint injection for primary dysmenorrhea can avoid the stimulation of the gastrointestinal tract by oral drugs, and the route of acupoint injection can make the drug quickly reach the lesion, which is conducive to the absorption of the drug, thereby improving the clinical efficacy. However, at present, there are few relevant studies on acupoint injection for primary dysmenorrhea, and there are fewer drugs applied to clinical practice, and the effectiveness and feasibility have certain limitations, and it is necessary to continue to research and explore in the future to find drugs more suitable for acupoint injection to achieve better treatment effects.
summary
Western medicine treatment of primary dysmenorrhea has a certain immediate analgesic effect, but it has no targeted effect on clinical accompanying symptoms, and the individual clinical efficacy varies greatly, and there are certain adverse drug reactions. Traditional Chinese medicine mainly takes dialectical treatment as the treatment principle, and selects treatment methods according to the symptom type. Dialectical treatment, external treatment, internal treatment, and internal and external combination of primary dysmenorrhea can exert certain therapeutic effects and control dysmenorrhea symptoms.
Especially with the continuous in-depth study of its pathogenesis, the treatment of primary dysmenorrhea by traditional Chinese medicine has become more mature, and the continuous improvement and optimization of clinical traditional Chinese medicine treatment methods have opened up ideas for the clinical treatment of primary dysmenorrhea. At present, there are still many shortcomings in the clinical research of traditional Chinese medicine in the treatment of primary dysmenorrhea, which need to be further observed and evaluated for long-term efficacy follow-up, and confirmed by large-sample and multi-center studies to benefit patients with clinical primary dysmenorrhea.