Acupuncture Treatment Of Primary Dysmenorrhea: Advantageous Plan Recommendation And Meta-Analysis

Objective By creating a modern literature database of acupuncture and moxibustion for the treatment of primary dysmenorrhea,we use data mining techniques and evidence-based medical methodologies to screen out the advantage treatment of PD and try to analyze its advantages in clinical efficacy,in order to provide basis for the study of acupuncture treatment of PD in clinical diagnosis and treatment plan.Methods Establish a modern literature database for the acupuncture treatment of primary dysmenorrhea,including clinical research,expert experience and case report,through literature retrieval from January 2000 to December 2016.Involved databases CBM,CNKI,Wanfang Database,VIP Database,Pub Med,MEDLINE,etc;Disease search terms “dysmenorrhea” “primary dysmenorrhea” “functional dysmenorrhea” etc.;Intervention search terms “acupuncture”“acupuncture and moxibustion”“Moxibustion” “Electro-acupuncture” and so on.According to the concept of“authenticity and importance principle of therapeutic evidence” in evidence-based medicine,the weight of included literature is given from three aspects: literature type,literature quality,and data accuracy.Data mining technology was used to summarize and analyze the treatment rules in three aspects: acupoint selection,intervention measures,intervention timing.Considering support and homeostasis,weight value and clinical efficiency,we recommend the treatment plan,and combining Evidence-based Guideline of Clinical Practice with Acupuncture and Moxibustion: Primary Dysmenorrhea,we finally screen out the advantage treatment plan for primary dysmenorrhea.According to the recommended advantage treatment plan,the acupoint prescription was set as the inclusion exclusion criteria for meta-analysis.By searching the randomized controlled study literature database,we included the relevant 3-6-point prescription literature,and to analysis the efficacy advantage of recommended advantage acupoint prescription,by comparing clinical efficacy of different acupoint prescriptions.Results1.Created a modern literature database of acupuncture treatment for PD,by searching 3,133 articles,eventually,261 articles were included.2.Data mining results showed that,(1)The use of acupoints: involved 73 body acupoints,sanyinjiao(155),guanyuan(142),zhongji(66)are frequently used.The specific acupoints are the main part,which accounted for 53.42%(39/73)of the total number of acupoints,and 95.23%(899/944)of the total use frequency and the number of the confluent acupoints and Five Shu acupoints are higher,and the confluent acupoints and the Mu-front points are more frequently.(2)Acupoint distribution: 11 meridians are involved,and the frequency of selection for Ren meridian,spleen meridian and bladder meridian are higher;the acupoints are mainly based on lower back,abdomen and lower extremities.(3)points prescription: The clinical prescriptions are more based on multi-acupuncture,the most commonly used double-acupoints,threeacupoints,and fou-acupoints are Guanyuan → Sanyinjiao;Zusanli → Sanyinjiao,Guanyuan;Zusanli,Qihai,Guanyuan → Sanyinjiao.(4)Acupuncture therapy and timing of intervention: traditional therapies are more used,mainly acupuncture,moxibustion,acupuncture and moxibustion,and acupuncture often chose 3-5 days before menstruation to intervene,the others chose 5-7 days.3.Analyzed the efficacy of the recommended acupoints in dysmenorrhea intermitting period,the “advantage acupoint prescription” was set to the 3-6 acupoints prescription based on “Sanyinjiao,Guanyuan,Zusanli”.Meta-analysis included 11 articles,involving 991 patients.5 articles about “advantage acupoint prescription”(575patients),6 articles about “other acupoint prescription”(589 patients).About methodological quality assessment,10 articles are “B” grade,and 1articles are “C”.Results:(1)“advantage acupoint prescription” VS “other acupoint prescription”:acupuncture and moxibustion are superior to drugs in all the terms of total efficacy,pain scores,and dysmenorrhea clinical symptom scores,and there were no significant differences in the efficacy of the two acupoint prescriptions.(2)Safety: there is no enough evidence that acupuncture is safer than drugs.Conclusion1.Modern acupuncture treatment for primary dysmenorrhea is mainly based on“local acupoint selection” and “meridian acupoint selection”,and more attention is payed to the specific acupoints and experience acupoints.The clinical acupoint prescription is mainly based on 3-5points.2.The recommended advantage prescription for PD:(1)Pain period,acupuncture shiqizhui,sanyinjiao,diji,ciliao(people who resist and fear acupuncture,select single point);(2)dysmenorrhea intermitting period,mainly choose acupuncture method to stimulate sanyinjiao,guanyuan and zusanli,and started treatment at 3 days before the menstruation.Both of them retained the needle for 30 minutes,1 time per day,3 days as 1 course of treatment for pain period,6 days for dysmenorrhea intermitting period,and continuous treatment of 3 courses.3.Meta-analysis showed that acupuncture treatment of primary dysmenorrhea is effective,and better than drug treatment,but lack of safety evaluation.Comparing different acupoint prescriptions,the “advantage acupoint prescription” did not reflect the clinical efficacy advantage in this study.