Scheme Optimization Of Acupuncture Treatment On Migraine In Phlegm And Blood Stasis Type At Attack Stage

ObjectiveObserve and compare the effect of different acupuncture methods on migraine in phlegm and blood stasis type at attack stage to choose the best acupuncture treatment prescriptions for it and to provide some guide for clinical application.MethodsBoth the stratified random and the orthogonal design are applied in this study.The orthogonal design that uses the orthogonal table of L₉(3⁴) is about 4 factors and 3 levels of each factor.The patients were classified first according to their gender,age and disease severity to make the 9 patients' condition isostatic in every repeated group and they are distributed to 9 treatment descriptions randomly after that.The blind method in evaluation is also used in this study.The study needs 27 cases. The 4 factors are combination of points(A),acupuncture or electro-acupuncture method(B),auricular acupuncture method(C) and bloodletting method(D). The 3 levels of factor A are local points(A1),local points together with distal points (A2) and local points,distal points together with points according to syndrome differentiation(A3).The 3 levels of factor B are no acupuncture(B1),acupuncture(B2) and acupuncture together with electro-acupuncture(B3).The 3 levels of factor C are no auricular acupuncture(C1),auricular acupuncture(C2) and auricular acupuncture together with electro-acupuncture(C3).The 3 levels of factor D are bloodletting at abnormal collateral around Taiyang(EX-H5) or Taiyang(EX-H5) together with Ashi(D1),bloodletting at abnormal collateral around Taiyang(EX-H5) or Taiyang(EX-H5)(D2) and no bloodletting(D3).Points:Local points are Sizhukong(SJ23),Shuaigu(GB8) Taiyang(EX-H5) and Fengchi(GB20).Points in both sides are used when the migraine is in both sides while points in the sick side are used when the migraine is in one side.Distal points are Hegu(LI4),Lieque(LU7),Taichong(LR3) and Zulinqi(GB41) in both sides. Points according to syndrome differentiation are Zhongwan(RN14),Fenglong(ST40), Xuehai(SP10) and Geshu(UB17) in both sides.Acupuncture and electro-acupuncture method:The penetration needle is used at Sizhukong(SJ23) and Shuaigu(GB8) and other points use conventional acupuncture method in depth of 1～1.3 cun.The electro-acupuncture in dilatational wave is used at points in the head on the base of acupuncture method and the strength should make the patient comfortable.Auricular acupuncture method:Points used in this method are Shenmen, sympathetic,subcortex,brain point and Ashi which is near the temple,forehead and occiput.The operation methods are the same as that of acupuncture and electro-acupuncture method.Bloodletting method:Points used in this method are abnormal collateral around Taiyang(EX-H5) or Taiyang(EX-H5) and Ashi.Pricking the points and expressing 10～15 drops of blood or some blood until the blood's color is normal.The duration of each treatment is 30 minutes and the course is 1 time. The differentiation of VAS between it before treatment and it 10 minutes,20 minutes, 30 minutes,1 hour,2 hour,3 hour,4 hour,5hour,6 hour,12 hour and 24 hour after treatment is used to evaluate the treatment effect.The analysis on cerebral blood flow of the arteries both in sick side and in health side by TCD is also used to verify the treatment effect.ResultsThe results of VAS:The general tendency of the 4 factors to relieve the migraine is as follows:factor D is the most important,factor B and C are almost the same,factor A is the least important.The function of B is obvious bigger than that of C in 1 hour while the function of C is obvious bigger than that of B during 5～24 hour.The function of them are almost the same during 1～5 hour except that C's stability is better than B.Above all,the best treatment method is bloodletting together with acupuncture or electro-acupuncture in 1 hour while during 1～24 hour,the best one is bloodletting together with auricular acupuncture.The functions of 4 factors are all very weak at the 24 hour,so the best treatment frequency for migraine at attack stage in phlegm and blood stasis type is once a day.The functions of 3 levels of factor A to relieve the migraine is A1＞A2＞A3.The function of 3 levels of factor B to relieve the migraine is B2＞B1＞B3.The function of 3 levels of factor C to relieve the migraine is C2＞C3＞C1.The function of 3 levels of factor D to relieve the migraine is D2＞D1＞D3. So the best acupuncture treatment prescription in 1 hour is bloodletting at abnormal collateral around Taiyang(EX-H5) together with acupuncture at local points.The best acupuncture treatment prescription during 1～24 hour is bloodletting at abnormal collateral around Taiyang(EX-H5) together with auricular acupuncture.The results of TCD:The reactions of cerebral arteries in sick side is obvious different to different treatment methods while that in health side is almost the same which means the acupuncture therapy effects the cerebral arteries in sick side mainly.Conclusions 1.The best acupuncture treatment prescription for migraine at attack stage in phlegm and blood stasis type in 1 hour is bloodletting at abnormal collateral around Taiyang (EX-H5) together with acupuncture at local points.2.The best acupuncture treatment prescription for migraine at attack stage in phlegm and blood stasis type during 1～24 hour is bloodletting at abnormal collateral around Taiyang(EX-H5) together with auricular acupuncture.3.In the acupuncture methods for migraine at attack stage in phlegm and blood stasis type,the bloodletting method is effective and stable,the acupuncture or electro-acupuncture method is effective in 1 hour while unstable after 1 hour,the auricular acupuncture is in contrary.4.The best treatment frequency for migraine at attack stage in phlegm and blood stasis type is once a day.5.The acupuncture treatment for migraine at attack stage in phlegm and blood stasis type effects the cerebral arteries in sick side mainly.6.The severity of migraine isn't so related to degree of fatigue.7.The routine influence factors of migraine are main diet,sleep,exercises,climate, and pollute air.Some cases are connected with heredity and women are related to menstruation.8.Young people can evaluate pain more objectively than middle aged people.Note:The conclusions above are suitable for women only.