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Primary dysmenorrhea and acupuncture

Primary dysmenorrhea and acupuncture: a clinical approach based on observational data.

题目: 原发性痛经与针灸: 基于观察数据的临床方法

Authors: Franco Menichelli, MD
作者: Franco Menichelli, MD

Affiliation:
President - Italian Association of Acupuncture (A.I.A.) www.agopuntura.it
单位:Italian Association of Acupuncture (A.I.A.) www.agopuntura.it
Vice President - Board of Supervisor Members of the WFCMS
副主席-世界中医药学会联合会监事会成员

Abstract
Dysmenorrhea refers to pelvic pain in correspondence with the menstrual flow, so intense that it prevents or reduces normal daily activities. This study aims to explore an integrative approach for the treatment of primary dysmenorrhea with acupuncture.
The use of extraordinary meridians, in particular the Chong Mai, is essential for treating this disease. Additional acupoints can be selected depending on the specific sub-type of primary dysmenorrhea.

Acupuncture can be considered as a first-line treatment option for primary dysmenorrhea, because it does not only improve pain, but it also ameliorates the other symptoms over time, thus having a curative role.

摘要:痛经是指与月经量相对应的盆腔疼痛,疼痛剧烈以致妨碍或减少正常的日常活动。
本研究旨在探索针灸治疗原发性痛经的综合方法。
使用奇经八脉的冲脉,对于治疗这种疾病至关重要。
可根据原发性痛经的具体亚型选择额外的穴位。
针灸是原发性痛经的一线治疗选择,因为它不仅可以治疗疼痛,而且随着时间的推移还可以改善其他症状,从而具有治疗作用。

Keywords: Acupuncture; Dysmenorrhea; Clinical Practice; Integrative Medicine; TCM
关键词: 针灸; 经痛; 临床实践; 中西医结; 中医.

Introduction
Dysmenorrhea refers to pelvic pain in correspondence with the menstrual flow, so intense that it prevents or reduces normal daily activities (Coco, 1999). In particular, primary dysmenorrhea is characterized by pelvic pain not associated with other pelvic diseases, whereas secondary dysmenorrhea is less frequent and usually associated with organic causes. Primary dysmenorrhea affects more than 50% of the female population of childbearing age and is so widespread that it can be considered one of the major causes of temporary absenteeism from work and school (De Sanctis, 2015). Overall, several treatment options can be considered for improving these patients’ symptoms and quality of life.
This study aims to explore an integrative approach for the treatment of primary dysmenorrhea with acupuncture.

Methods
This study includes a theoretical approach based on the main principles of traditional Chinese medicine and bioenergetics, along with observational results from the author’s clinical experience. Clinical data were fully anonymized and informed consent was obtained from the patients involved.
Here we consider four sub-types of primary dysmenorrhea, and the acupuncture treatments were tailored accordingly (Alfidi, 2013).
Sub-type 1 refers to uncomplicated/simple primary dysmenorrhea, usually affecting young women without any comorbidities, but with cervical stiffness. In this case, the following acupoints are chosen: REN-4-5-6, ST-30, GB-34, GB-38, GB-43 (on both sides). This treatment can be administered even during the menstruation period, while the other treatments should be delivered 1-to-7 days before the menstruation period.
Sub-type 2 refers to Yang Ming dysmenorrhea, only characterized by abdominal pain irradiated to the legs. In this case, the following acupoints are chosen: Sp-4, Pc-6, St-30, CV-4, CV-5, St-36, St-43, St-44, and Ki-7 (manual or electrical tonification).
Sub-type 3 refers to Tai yang dysmenorrhea, characterized by low back pain. In this case, the following acupoints are chosen: Sp-4, Pc-6, St-30, CV-4, CV-5, GV-3, Bl-31, Bl-59, Bl-60, Bl-63, and Ki-7 (manual or electrical tonification).
Sub-type 4 refers to Yang Wei dysmenorrhea, characterized by digestive problems, cramps, and headache. In this case, the following acupoints are chosen: Sp-4, Pc-6, St-30, CV-4, CV-5, GV-3, Tb-5, St-25, Gb-41, Gb-34, Gb-38, Bl-63, and Ki-7 (manual or electrical tonification).

Results
In total, 70 patients with primary or secondary dysmenorrhea were treated with individualized acupuncture protocols (1-3 treatment sessions every month, before the menstrual period) always including the Chong Mai sequence (Sp-4, Pc-6, St-30, CV-4, CV-5) plus additional acupoints based on the subject’s characteristics and the disease features (Menichelli, 2019). The average follow-up period was around 3 years. Among the patients treated, 52% of them fully recovered, with complete resolution of pain; 17% of them reported reduced pain (so mild that it was controlled with modest and discontinuous use of NSAIDs); 6% of them reported no changes in their symptoms; and 9% of them are still under treatment. Overall, the treatment effectiveness was estimated to be around 69%. However, if we had limited the cases to those with primary dysmenorrhea, the effectiveness would be superior.

Discussions
In light of our clinical experience, acupuncture can be considered as a first-line treatment option for primary dysmenorrhea, because it does not only improve pain, but it also ameliorates the other symptoms over time, thus having a curative role. Furthermore, for several patients three treatment sessions (once a month for three consecutive months) were enough to improve the symptoms over the years to come, without any need for additional treatments.
Finally, acupuncture did not only prove useful to improve the patients’ symptoms, but it was also well tolerated by the subjects involved, without any particular side effects.

References
Alfidi, A. (2013). Agopuntura clinica. Endocrinologia ginecologica 1. Disturbi minori del ciclo mestruale. La dismenorrea.
Coco, A. S. (1999). Primary dysmenorrhea. American family physician, 60(2), 489.
Menichelli, F. (2019). Insegnamenti di agopuntura vol.4.
Vincenzo De Sanctis, M., Soliman, A., Bernasconi, S., Bianchin, L., Bona, G., Bozzola, M., ... & Perissinotto11, E. (2015). Primary dysmenorrhea in adolescents: prevalence, impact and recent knowledge. Pediatric Endocrinology Reviews (PER), 13(2), 465-73.

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