| Objective:1. To study the clinic effects of warming needle with moxibustion and Shen Que moxibustion treating primary dysmenorrhea, and it's timely effect of analgesia. Compared its therapeutical effects with regularly acupuncture.2. To observe the effect of Shen Que moxibustion on the mice thymus gland, spleen and uterus pathologic changes, endometrium PGF2a, hypothalamus and plasmaβ-EP, peripheral blood T lymphocytes subgroup percentage and uterine smooth muscle gap junction protein 43. To analyse the function of Shen Que moxibustion treating primary dysmenorrhea by easing pain and promoting immunity, and study the mechanism of Shen Que moxibustion treating primary dysmenorrhea related to Neuro-Endocrine-Immunity network.Methods:1. In openly randomized control clinical trial,90 primary dysmenorrhea patients were recruited and ramdomized into 3 groups:intervention, acupuncture control and control.30 cases each group. Observed for 4 menstrual cycles. On the first day when dysmenorrheal symptoms occurred in the first menstrual cycle, VAS≥40mm, treated patients with warming needle with moxibustion and Shen Que moxibustion. Assessed the timely effects on the pain level by Visual Analogue Scale (VAS). Treated patients 3 days before the second menstrual cycle, qd, continued for 3 days till mensus occurred, one menstrual cycle is as a course of treatment. kept treating for 3 course. The Retrospective Symptom Scale(RSS) were filled by the patients to assess the total frequency ratings and average severity level of patients'dysmenorrheal symptoms that refers to the average level of pain and the condition changes when it did occur.2.48 NIH female mice were randomly divided into three groups:control, model and moxibustion.16 each group. For the control group, gave the mice NS for 12 days, when gave NS the last day one hour later, ip the mice with NS. And for model and moxibustion groups, The primary dysmenorrheal animal model was made by diethylstilbestrol and oxytocin. Gave moxibustion treatment the moxibustion group mice everyday after model made,15min each time, continued for 12days, when gave the last diethylstilbestrol one hour later, injected oxytocin, observed the mice twisting frequency and the mice thymus gland, spleen and uterus pathologic changes. Tested T lymphocytes subgroup percentages of CD4+ and CD8+ by flow cytometer. Tested the mice endometrium PGF2 a, hypothalamus and plasmaβ-EP by RIA and tested the mice uterine smooth muscle gap junction protein 43 by IHC.Results:1. In the intervention group and acupuncture control group, Compared the symptom RSS score between every course of treatment and that before trial and that at same time of control group, the total frequency rating and average severity rating of abdominal pain and average whole dysmenorrheal symptom are obviously decreased(P<0.01). It shows the two treatment both can relieve patients'pain level. During treating,both groups'VAS score continue decreased, but a little rise again at the time of 30 minutes after treating than that time treating for 30minutes.The VAS score decreased most obviously when treating 30 minutes. When treated for 40 minutes, maybe acupuncture tolerability occurs. It indicates that two treatments'effects for easing pain have positive correlation with treatment time in 30 minutes. And treatment for 30 minutes'effect is the best for easing pain. Compared intervention group with acupuncture control group at same term, treating for 10 minutes, the score difference is meaningful (P<0.05), score difference at other terms are obvious (P<0.01), it shows that the therapeutic effect of warming needle with moxibutsion and Shen Que moxibustion is superior than regular acupuncture. Before the trial, The abdominal pain is the most severe symptom before trial, other symptoms such as weakness, less of appetite, backaches, irritability, and depression are also severe. In the intervention group and acupuncture group, Compared the three course score with that before trial and that of control group at same term, the total frequency rating and average severity level of patients'dysmenorrheal symptoms and abdominal pain all decreased, especially in the second and third course (P<0.01). The intervention group score decreased more obviously than acupuncture group. It dedicates that two treatments both can decrease dysmenorrheal symptoms'frequency rating and average severity level, and effect accumulates along with treatment course, dysmenorrheal symptoms are also relieved, the therapeutical effect of warming needle with moxibustion and Shen Que moxibustion is obviously superior than regular acupuncture treatment.2. The twisting frequency of model group mice is obviously higher than control group, and that of moxibustion group is lower than model group. Compared with control group, the mice endometrium PGF2a,the hypothalamus and plasmaβ-EP of model and moxibustion group are obviously increased, the percentage of CD4±is obviously lower, the percentage of CD8±is obviously higher, and ratio of CD4+/CD8+ gets down(P<0.01). Compared with model group, the moxibustion group mice endometrium PGF2a decreased (P<0.05), the hypothalamus and plasmaβ-EP increased(P<0.05), and CD4+ increased (P<0.05), CD8+ is lower slightly (P>0.05), the ratio of CD4+/CD8+ get higher (P>0.05). The model mice's thymus gland peripheral cortex area and cells reduced, medulla capillary vessel hyperemia, and spleen lymphoid nodule amount and area decreased. Uterus glandular lumen and endometrium mesenchyme hyperemia and edema. Compared with model group, the mice of moxibustion group thymus gland peripheral cortex area and cells and spleen lymphoid nodule amount and area all increased, glandular lumen and endometrium mesenchyme hyperemia and edema was relieved. Cx43 of endometrium in the control group mice is negative, it's positive in model group, and slightly positive in moxibustion group.Conclusions:1. The treatment of warming needle with moxibustion and Shen Que moxibustion can obviously decrease the primary dysmenorrheal patients' abdominal and dysmenorrheal symptoms'toal frequency rating and average severity level. And the effect accumulates along with treatment courses, This treatment can relieve the dysmenorrheal symptoms and pain level of primary dysmenorrheal patients.In 30 minutes of treating, its effect of easing pain positively correlates with treatment time. And It has the best easing pain effect at the time of treating 30 minutes. The effect of warming needle with moxibustion and Shen Que moxibustion is obviously superior than regular acupuncture.This treatment has practical and reliable for treating primary dysmenorrheal.Acupoints choice is refined and less, and combine the function of acupuncture and moxibustion, it's good for clinical popularization.2. Shen Que moxibustion is effective for easing pain. It can regulate the mice's uterus blood circulation, relieve Uterus glandular lumen and endometrium mesenchyme hyperemia and uterus spasm, decrease endometrium PGF2 a. Dysmenorrhea itself maybe can activate central nervous EOP system irritantly, moxibustion maybe promote CNS to produce and release much moreβ-EP, and also increase theβ-EP level in plasma to play the role of analgesic action. The functional mechanism of moxibustion on mice uterus spasm and pain maybe through adjusting Cx43 gap junction.3. Shen Que moxibustion can adjust dysmenorrheal model mice's immunity function. It can up-regulate the percentage of CD4+ and the ratio of CD4+/ CD8+, maybe play the role of positively adjusting dysmenorrheal model mice's immunity disorder. Shen Que moxibustion also can lighten the thymus gland and spleen pathological lesion to recover and promote the two organs'immunity function. PGF2a maybe related to the dysmenorrheal model mice's immunity disorder, and Shen Que moxibustion adjusts the disorder maybe related to CNS and plasmaβ-EP expression.4. Neuro-endocrine-immunity network disorder in dysmenorrheal model mice maybe occurred. And the action mechanism of Shen Que moxibustion on primary dysmenorrheal maybe through neuro-endocrine-immunity network, adjust organs and meridians'function, balance body yin and yang, and stabilize internal environment.
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