| Pelvic inflammatory disease refers to the inflammatory syndromes of female internal genital organs and the peripheral connective tissue and pelvic peritoneum and is usually classified into acute and chronic pelvic inflammatory disease. If acute pelvic inflammatory disease can't be completely cured, it will possibly turn into chronic pelvic inflammatory disease. Chronic pelvic inflammatory disease mainly include chronic salpingitis, hydrops tubae, chronic salpingo-ocphoritis, tubal ovarian cyst and chronic pelvic paramitritis among which salpingitis and salpingo-ocphoritis are the most frequently occurred diseases.Chronic pelvic inflammatory disease is common and frequently occurred gynecological disease which mainly occurs to women at sex active phase and with menstruation. It's mostly caused by the incompletely treated acute pelvic inflammatory disease or the prolonged disease course due to patients' poor constitution. It's a stubborn disease and causes mental and physical pain to patients. The common symptoms repeated for long term are distention and pain of lower abdomen, sour pain of lumbosacral area, disease aggravation after tiring work or sexual life, lassitude or low fever. To some patients, they don't have the obvious abdomen pain and just have the neurasthenia symptoms like spiritless, insomnia and lassitude, etc. It's hard to cure completely and seriously detriment women's mental and physical health. In recent years, the incidence of this disease rises. Modern research believes that chronic pelvic inflammatory disease is caused by desmoplasia which causes the concretion of oviduct and ovaries with the peripheral organs and tissues, so there's cicatricial contracture and unsmooth blood circulation, or enclosed mass and hydrops which brings about focal zone malabsorption. Therefore, the disease course is long and it's hard to cure. It needs long-term medication while antibiotics don't have good effect and on the contrary has many side effects. Chinese Herbal Medicine has unique advantages in treating this disease. In Western Medicine Gynecology textbooks, chronic pelvic inflammatory disease is the only disease that lists Chinese Herbal Medicine as the major treatment plan. In recent year, comprehensive therapy including Chinese Herbal Medicine intake, coloclysis, applying ointment, acupuncture, physical therapy and intravenous transfusion of Chinese Herbal Medicine. Chinese Herbal Medicine can activate blood circulation, solve stagnation, disperse coldness and dampness, promote qi circulation, relieve pain, soften hard lumps, dispel nodes, clear heat and detoxicate. It can soften and solve cicatricial tissue and improve the pelvic blood circulation, so it can promote the absorption of inflammatory lumps and hyperplastic tissue and improve the symptoms. Therefore, it is an effective therapy to treat chronic pelvic inflammatory disease.This thesis consists of literature review and clinical research.In the literature review part, the author has researched on the definition, etiology and pathogenesis of chronic pelvic inflammatory disease in Chinese Medicine and acquired complete understanding. The author has reviewed development in differentiation types and Chinese Medicine therapies of recent years and made conclusive demonstration. From the angle of Western Medicine, the author summarized comprehensively the definition, the route of infection of pathogen, the clinical demonstration and diagnosis of the disease and evaluated the pharmaceutical treatment development.The clinical research part:ObjectiveThis study observes the clinical effect and safety of the therapy of moxibustion plus Chinese Herbal Medicine retention enema to treat chronic pelvic inflammatory disease of humid heat stagnation with the expectation of providing safety and pharmacodynamics basis for clinical application.MethodsAll the subjects are chronic pelvic inflammatory disease patients from Yong Shun Chinese Medicine Clinic.80 were selected according to case inclusion and exclusion criteria. With randomized controlled trial methods, the subjects are classified into Treatment Group (moxibustion plus Chinese Medicine retention enema) and Controlled Group (Chinese Herbal Medicine) with 40 subjects in each group at the rate of 1:1. Therapy:Treatment Group:30 g each of sargentgloryvine stem, danshen root, and white flower patrinia harb; 30 g each of common burreed tuber, paeoniae radix, cortex phellodendri, amoorcorn tree bark, corydalis tuber; 10 g of safflower,20 g of Tokyo violet herb. Operation:Decoct at 37℃-38℃. The patient takes side-lying position and raises rumps at 10 cm. Insert anal canal into anus at about 15 cm, transfuse Chinese Medicine decoction into the enteric cavity in 15 minutes and retain it for 1 hour. Conduct retention enema every evening.10-15 days make a treatment course and treat 2 courses. Stop treatment during menstruation. Moxibusition operation:Put 1 moxibustion stick in the moxibustion box (18 cm of length,14 cm of width and 10 cm of height with barbed wire at 6 cm above box bottom). Apply moxibustion at Zigong, Guanyuan and Baliao acupoints. Apply to the abdomen and back acupoints alternatively. The treatment course is the same as the former one. Evaluate the effect after 2 courses. Controlled Group: 15 g each of sargentgloryvine stem, danshen root, white flower patrinia harb, and Tokyo violet herb, each of common burreed tuber, paeoniae radix, cortex moutan, amoorcorn tree bark, corydalis tuber; 10 g of cortex phellodendri and safflower. Take orally 1 dosis every evening as the Treatment Group. Observation indexes:Improvement of clinical symptoms before and after treatment, Type B ultrasonic gynecological examination before and after treatment, Blood rheology examination before and after treatment:higher and lower whole blood viscosity, plasma viscosity, VPRC, blood sedimentation and profibrin. And Safety examination:blood, urine and stool routine tests, electrocardiogram examination and liver and kidney function examination.Result1. Compare the comprehensive total clinical effect and Chinese Medicine syndrome effect of two groups before and after treatment with rank sum test, and the author finds the difference has statistical significance (P<0.01) The difference of the total effective power of two groups compared with chi square test also has statistical significance. It can be confirmed that the Treatment Group has superior curative effect than the Controlled Group.2. Compare the curative effect of each Chinese Medicine symptoms of two groups, and the author finds that there's statistical significance (P<0.05) at the improved degree of symptoms including lower abdomen distention and pain or pricking pain, lumbosacral area pain and distention, large quantity of fluor and abdomen pain during menstruation. It can be confirmed that the Treatment Group is superior to the Controlled Group in improving Chinese Medicine symptoms.3. Compare the curative effect of body signs of two groups, the author finds that there's statistical significance (P<0.05) in the difference of body signs including adhesions of uterus, fixed tenderness, appendant thickening, etc. It can be confirmed that the Treatment Group is superior to the Controlled Group in curative effect of body signs.4. Compare the blood rheolgy indexes before and after treatment within two groups by pair t test, and the author finds the difference has statistical significance which indicates that the indexes are improved significantly in the two groups after treatment. The interclass comparison of the two groups after treatment by t test shows statistical significance (P<0.05) in lower whole blood viscosity, plasma viscosity, blood sedimentation, VPRC and profibrin.ConelusionThis clinical research shows that therapy of moxibustion plus Chinese Herbal Medicine retention enema can effectively improve the symptoms of chronic pelvic inflammatory disease of humid heat stagnation. During medication, no detriment to liver and kidney function and routine blood safety indexes is found. It's a safe and effective medication route with Chinese Medicine advantages and provides advantageous theoretical foundation for its clinical promotion.
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