A Study On The Correlation Between The Specificity Of Meridian Reaction/effect And Syndrome Type

Objective (1) To discuss Traditional Chinese Medicine (TCM) causes and pathogenesis of primary dysmenorrhea (PD) through questionnaire investigation on patients and to provide basic materials for clinical researches.(2) To explore the relationship between TCM pattern and the specificity of acupoint reaction through a TCM pattern subdivision analysis on the differences of acupoint temperature and electrical resistance in PD patients.(3) To explore the relationship between TCM pattern and the specificity of acupoint effect through a TCM pattern subdivision analysis on data from a multi-center, randomized, controlled trial with electroacupuncture for PD.Methods (1) This is a questionnaire investigation on168PD patients from9colleges in Beijing. On the first painful day in menstruation, every subject finished the patient part questionnaire and then the recorder gave TCM pattern diagnosis and filled doctor part questionnaire when the visual analogue scale (VAS) score of menstrual pain was equal or more than40mm. The usual status, menstrual period conditions and pattern distribution of these patients were surveyed.(2) The acupoint temperature and electrical resistance of52PD patients from a Beijing university was detected. On the first painful day in menstruation, each patient got TCM pattern diagnosis and the skin temperature and electrical resistance of three points, Sanyinjiao (SP6), Xuanzhong (GB39) and an adjacent non-acupoint, was continuously measured for60and30minutes respectively. The temperature differences and differential values of electrical resistance between right and left points of the same name were compared.(3)501PD participants, from6hospitals in3provinces, were randomly and equally divided into three treatment groups with bilateral electroacupuncture at three acupoints respectively:SP6, GB39, and the non-acupoint. The intervention was carried out when the VAS score of participant's menstrual pain was?40mm on the first day of menstruation and lasted for30minutes with alternating2/100Hz waves at the highest intensity each participant could tolerate. Participants were diagnosed with TCM patterns before the treatment. The immediate improvement of pain was measured with a100-mm VAS before the intervention, at5min,10min and30min during the intervention, and at30minutes after the completion of this intervention. The proportion of responders which was defined as the proportion of patients with at least a50%reduction in the VAS points was also compared.Results (1)163(98.19%) of166questionnaires were collected. Of all the163respondents who finished this investigation,69.94%averted to cold,57.06%had cold limbs,77.30%preferred warm food and drinks and83.44%did physical activities less than3times weekly as usual. There were78.53%and64.42%patients whose menstrual pain were caused or aggravated by taking cold food and drinks or by washing clothes with cold water. While there were66.26%patients whose menstrual pain were relieved by eating warm food and drinks and74.23%by applying hot compress on lower abdomen. When menstrual pain occurred,69.33%patients had more motions and more watery, soft stools than usual and61.35%and56.44%had sunken pulse in the left and right Chi position respectively.68.10%was diagnosed as Cold and Dampness Stagnation pattern.(2)?There were52PD patients who finished skin temperature measurements, including35patients with single TCM pattern:22patients with Cold and Dampness Stagnation pattern,7with Qi and Blood Stagnation pattern,3with Qi and Blood Deficiency pattern, another3with Obstruction of Damp-heat pattern and none with Deficiency of Liver and Kidney pattern. The latter three patterns failed analysis for few data. There was no differences in temperature differences among the three detected points in Cold and Dampness Stagnation pattern or Qi and Blood Stagnation pattern (p=0.71;0.85).?Altogether46PD patients finished skin electrical resistance measurements, including32patients with single TCM pattern:21patients with Cold and Dampness Stagnation pattern,6with Qi and Blood Stagnation pattern,2with Qi and Blood Deficiency pattern,3with Obstruction of Damp-heat pattern and none with Deficiency of Liver and Kidney pattern. The latter three patterns failed analysis for few data. In Cold and Dampness Stagnation pattern, the differential values of electrical resistance among the three detected points were different (p=0.003). The differential value of electrical resistance of SP6was significantly higher than GB39(p=0.002) but there was no differences between SP6and the non-acupoint (p=0.08) or between GB39and the non-acupoint (p=0.36). There was no differences in differential values of electrical resistance among the three points in Qi and Blood Stagnation pattern (p=0.22).(3) Of all the501PD patients,323were diagnosed as single TCM pattern, and of them, the most common pattern was Cold and Dampness Stagnation pattern (n=184), followed by Qi and Blood Stagnation pattern (n=84) and Qi and Blood Deficiency pattern (n=52) and few participants with Obstruction of Damp-heat pattern (n=2) or Deficiency of Liver and Kidney pattern (n=1), so we did analysis of the former3patterns. In Cold and Dampness Stagnation pattern, for VAS points throughout the one hour monitoring period, the repeated measures ANOVA showed a significant group effect (p=0.003):The SP6group had a significant reduction in VAS points at5measurement times compared with the GB39group (p-0.003) and the non-acupoint group (p=0.002) respectively in group pair wise comparisons. But there was no significant differences between the GB39group and the non-acupoint group (p=0.81). While for Qi and Blood Stagnation pattern and Qi and Blood Deficiency pattern, there was no group differences (p=0.97; p=0.07). Besides, the responders rates were different in Cold and Dampness Stagnation pattern: the SP6group had better responders rate than the GB39group (p=0.003) and the non-acupoint group (p<0.001) and there was no difference between the latter two groups (p=0.45). There was no group differences in the proportion of responders in Qi and Blood Stagnation pattern and Qi and Blood Deficiency pattern (p=0.73:p=0.94).Conclusions (1) This study suggested that the TCM cause of PD is cold pathogen and the major TCM pathogenesis is accumulation of cold and dampness in uterus resulting from exterior cold pathogen. The most common pattern was Cold and Dampness Stagnation pattern.(2) We found that there was no differences in temperature differences between SP6and GB39or the non-acupoint but the differential value of electrical resistance of SP6was significantly higher than GB39in Cold and Dampness Stagnation pattern. While there was no differences in temperature differences and differential values of electrical resistance between SP6and GB39or the non-acupoint in Qi and Blood Stagnation pattern. It was suggested that the reaction specificity of acupoint electrical resistance may be related to TCM pattern. However, there was lack of evidence for the relationship between reaction specificity of acupoint temperature and TCM pattern.(3) In Cold and Dampness Stagnation pattern, compared with the GB39group and the non-acupoint group, the SP6group had a significant reduction in VAS points and a significant higher responders rate. There was no group differences of the VAS points and responders rates in Qi and Blood Stagnation pattern or Qi and Blood Deficiency pattern. It was suggested that TCM pattern might affect acupoint-specific effect on the immediate pain relief obtained by patients with PD.