針灸治療原發性痛經之實證醫學研究分析

Evidence-Based Study for the Acupuncture Treatment of the Primary Dysmenorrhea

原發性痛經（Primary dysmenorrhea）是常見且嚴重困擾女性的疾病，尤其好發於青少女，盛行率約67.2%~90%，在中醫文獻中也稱為「經痛」或「經行腹痛」，在治療上各有特色，百家爭鳴，可供選擇的方法很多。因此本研究是針對以針灸治療原發性痛經的文獻中，選取較為嚴謹且具有實證醫學（Evidence Base Medicine，簡稱EBM）的論文進行整理，並從中選取對於原發性痛經最具臨床療效的方法，首先在PubMed找到與原先設定理想條件較符合的文章共49篇，選擇文獻條件包括：考量與情境符合PICO的需求、有具體證據、發表時間較近…等，選出證據力等級最高的文獻四篇論文，繼之以效度(Validity)、效益(Impact)、臨床應用性(Practice)三個條件分析這四篇文獻，結果發現針灸可以立即緩解原發性痛經的症狀，而且止痛效果不亞於NSAID類藥物；此外也提出主要及次要的治療穴位，包含主要取穴：三陰交穴、太衝穴、公孫穴、足三里穴、腎俞穴，次要取穴：血海穴、氣海穴、太谿穴、命門穴、陽陵泉穴、曲池穴、合谷穴等；最佳的治療方案為安排患者於月經週期第一天開始治療，針灸的頻率為每次三十分鐘，每天一次，連續治療三天為一個療程。整體而言，針灸在治療原發性痛經顯然有其療效，至於並用藥物治療的效果未來更值得深入探討。

Primary dysmenorrhea is a common and bothered female disease. The prevalence of primary dysmenorrhea is about 67.2% to 90%, which is easily been found in teenage girls. There have many treatments reported in tradition chinese medecine literatures. We read some evidence based medicine articles which treated primary dysmenorrhea by acupuncture and found the most effective methods. First, we found 49 articles based on: PICO, specific evidence and issuing time from PubMed. We selected four articles by the level of evidence. Then, we judged those articles by validity, impact and practice. We founded acupuncture could immediately release symptoms caused by dysmenorrhea and the pain release was no less than NSAIDs. The main acupoints in treating primary dysmenorrhea were SP6, LR3, SP4, ST36, BL23 and the secondary acupoints were SP10, RN6, KI3, DU4, GB34, LI11, LI4. It was better to start treatment on the first day of menstrual cycle and the frequency was 30 minutes each time, once a day and last for three days. At the end, acupuncture has obviously efficacy in treating primary dysmenorrhea. It is worth to further discuss with the effects of treating primary dysmenorrhea with acupuncture and herb.