Clinical study of body acupuncture combined with auricular point pressing in the treatment of menstrual headache of the hyperactive liver fire type

OBJECTIVE: Menstrual headache refers to a condition in which headache is the main manifestation at each menstrual period or before and after menstruation. It corresponds to "menstrual migraine" in modern medicine; according to surveys, menstrual headache accounts for about 60% of migraine in women and is a common gynecological disease. Owing to the faster pace of modern life, greater work pressure and mental tension, its incidence is rising year by year, seriously affecting women's normal work and quality of life. At present, Western medicine has many drugs for menstrual headache (such as sex hormones, calcium channel blockers, sedatives and analgesics); although effective, they have many adverse reactions, a high recurrence rate and poor long-term efficacy, and a satisfactory therapy is still lacking. Acupuncture of traditional Chinese medicine shows clear advantages in treating this disease. Body acupuncture combined with auricular point pressing for menstrual headache of the hyperactive liver fire type is an empirical treatment explored by the supervisor, Professor Sun Lihong, on the basis of TCM theory in long-term clinical practice. It holds that, because of the faster pace of modern life, heavy work pressure, mental tension and emotional disturbance, women are prone to disharmony of the Chong and Ren vessels and hyperactive liver fire disturbing the clear orifices upward, which triggers menstrual headache. Therefore, according to these pathogenic characteristics and with the treatment principle of "regulating the Chong and Ren, clearing the liver and purging fire, dredging the collaterals and relieving pain", Baihui, Fengchi, Sanyinjiao, Taichong, Xiaxi, Taiyang, Hanyan, Xuanlu and Shuaigu were needled and combined with auricular point pressing, with good efficacy. By observing changes in symptom scores, VAS scores, onset time of analgesia and related biochemical indices before and after treatment, this study evaluated the clinical efficacy of body acupuncture combined with auricular point pressing for menstrual headache and explored its mechanism of action, to provide a safe, effective, simple and practical non-drug therapy without toxic side effects. METHODS: 85 patients with menstrual headache of the hyperactive liver fire type, all from the outpatient department of the Normal University Hospital between March 2010 and December 2011, were selected according to the diagnostic and inclusion criteria and randomly divided into a treatment group (43 cases) and a control group (42 cases). Treatment group: body acupuncture combined with auricular point pressing. (1) During headache attacks: body acupuncture and auricular pressing combined. First, 30-gauge 1.5-2 cun needles were inserted at Baihui, Fengchi, Sanyinjiao, Taichong, Xiaxi, Taiyang through Hanyan, Hanyan through Xuanlu and Xuanlu through Shuaigu, once a day for 3 days; then auricular pressing with Vaccaria seeds was applied bilaterally at Shenmen, Temple, Liver, Gallbladder, Subcortex and Sympathetic, and patients were told to press them themselves 3 times a day, for 3 days. (2) Premenstrual regulation: auricular pressing alone, starting 3 days before menstruation, unilaterally at Endocrine, Ovary, Shenmen, Subcortex, Liver, Spleen and Kidney, alternating ears, with the same procedure, until menstruation began. Control group: oral flunarizine hydrochloride capsules (Sibelium), 5 mg per dose, twice a day, starting 1 week before menstruation, for 2 weeks. Both groups were treated for 3 courses (menstrual cycles) and followed up for 3 months; clinical headache symptom scores, VAS scores and onset time of analgesia in each course were observed before and after treatment in both groups. Thirty patients were randomly selected from each group; venous blood was drawn before treatment and within 48 h of menstruation in the first month of follow-up (after the end of treatment) to measure plasma beta-endorphin (β-EP), vasopressin (AVP), endothelin-1 (ET-1), serum prostaglandin F2α (PGF2α), prostaglandin E2 (PGE2) and nitric oxide (NO). A normal group of 20 cases (healthy women aged 18-40 years without menstrual headache) had venous blood drawn within 24 h of any menstruation to measure the same biochemical indices for comparison with the treatment and control groups. Data for all indices before and after treatment were recorded and analyzed with SPSS 13.0. RESULTS: 1 Comparison of efficacy between the treatment and control groups: the total effective rate was 95.35% in the treatment group and 80.95% in the control group; by X2 test the treatment group was superior to the control group (P<0.05). By Wilcoxon rank-sum test of overall efficacy and of efficacy in patients with mild, moderate and severe headache, the overall efficacy of the treatment group was clearly superior to the control group (P<0.01); in moderate and severe cases the treatment group was clearly superior to the control group (P<0.05), and in mild cases both groups were effective (P>0.05). 2 Comparison of headache symptom scores before and after treatment: before treatment the symptom scores of both groups were balanced, with no significant difference (P>0.05), and comparable. (1) Treatment group: the 1st course compared with the 2nd and 3rd courses and the 3 months of follow-up showed very significant differences (P<0.01); the 2nd and 3rd courses differed very significantly (P<0.01). (2) Control group: the 1st course compared with the 2nd and 3rd courses and the 3 months of follow-up showed significant differences (P<0.01 or P<0.05); the 2nd and 3rd courses differed significantly (P<0.05). (3) Between groups: the 2nd and 3rd courses and each follow-up month of the treatment group compared with the corresponding courses and months of the control group showed very significant differences (P<0.01). Symptom scores after each course and during the 3 months of follow-up (at menstruation) were clearly lower than before treatment in both groups, but the reduction was more marked in the treatment group. 3 Comparison of headache VAS scores before and after treatment: before treatment the VAS scores of both groups were balanced, with no significant difference (P>0.05), and comparable. (1) Treatment group: before vs after the 1st course, very significant difference (P<0.01); the 1st course vs the 2nd and 3rd courses and the 3 months of follow-up, very significant differences (P<0.01); 2nd vs 3rd course, very significant difference (P<0.01). (2) Control group: before vs after the 1st course, significant difference (P<0.05); the 1st course vs the 2nd and 3rd courses and the 3 months of follow-up, significant differences (P<0.01 or P<0.05); 2nd vs 3rd course, no significant difference (P>0.05). (3) Between groups: after the 1st course, very significant difference (P<0.01); 2nd course, no significant difference (P>0.05); the 3rd course and the 3 months of follow-up of the treatment group vs the control group, very significant differences (P<0.01). VAS scores after each course and during the 3 months of follow-up (at menstruation) were clearly lower than before treatment in both groups, but the reduction was more marked in the treatment group. 4 Comparison of onset time of analgesia after each course: in both groups, onset time after the 1st course vs after the 2nd course showed no significant difference (P>0.05); after the 3rd course vs after the 1st course, very significant differences (P<0.01); in the treatment group, after the 3rd vs the 2nd course, significant difference (P<0.05); in the control group, after the 3rd vs the 2nd course, no statistically significant difference (P>0.05); onset time after the 1st, 2nd and 3rd courses in the treatment group vs the corresponding courses in the control group, statistically significant differences (P<0.01). Onset time of analgesia was shortened after each course in both groups, especially after the 3rd course, and more markedly in the treatment group. 5 Comparison of related biochemical indices before and after treatment: before treatment, plasma AVP and ET-1, serum PGF2α and the PGF2α/PGE2 ratio were clearly higher in the treatment and control groups than in the normal group (P<0.01); plasma β-EP and serum PGE2 and NO were clearly lower than in the normal group, with statistically significant differences (P<0.01). After treatment, plasma AVP and ET-1, serum PGF2α and the PGF2α/PGE2 ratio were clearly lower than before treatment in both groups, with statistically significant differences (P<0.01); plasma β-EP and serum PGE2 and NO were clearly higher than before treatment, with statistically significant differences (P<0.01). After treatment, changes in plasma ET-1, serum PGF2α and PGE2 and the PGF2α/PGE2 ratio were more marked in the treatment group than in the control group, with statistically significant differences (P<0.01 or P<0.05), while changes in plasma β-EP and AVP and serum NO did not differ significantly from the control group (P>0.05). After treatment, plasma β-EP, AVP and ET-1, serum PGF2α, PGE2 and NO and the PGF2α/PGE2 ratio in the treatment group did not differ significantly from the normal group (P>0.05); in the control group, plasma AVP and β-EP and serum PGF2α and NO did not differ significantly from the normal group (P>0.05), while plasma ET-1, serum PGE2 and the PGF2α/PGE2 ratio differed significantly from the normal group (P<0.01 or P<0.05). CONCLUSION: 1 Both body acupuncture combined with auricular point pressing and oral Sibelium reduced headache symptom scores and VAS scores and shortened the onset time of analgesia, but the former was superior to the latter. Both treatments have good analgesic effects, effectively improving headache symptoms, reducing pain severity and shortening pain duration, while the analgesic effect of body acupuncture combined with auricular pressing is stronger: it relieves pain quickly, has good long-term efficacy and a definite clinical effect. 2 Both treatments reduced plasma AVP and ET-1, serum PGF2α and the PGF2α/PGE2 ratio and increased plasma β-EP and serum PGE2 and NO in patients with menstrual headache of the hyperactive liver fire type, and body acupuncture combined with auricular pressing clearly improved all indices. Both treatments regulate these indices well, but the regulating effect of body acupuncture combined with auricular pressing is more marked; it can further regulate abnormal levels of neurohormones and vasoactive substances, thus relieving the spastic contraction of cranial vessels, increasing blood flow and improving cranial ischemia and hypoxia, thereby exerting its analgesic effect. 3 Body acupuncture combined with auricular point pressing produced no adverse reactions in clinical use and avoids side effects of oral Sibelium such as somnolence, fatigue, depression and gastrointestinal symptoms; it is a safe and reliable therapy. 4 Body acupuncture combined with auricular point pressing is a safe, effective, simple, less painful treatment without toxic side effects for menstrual headache of the hyperactive liver fire type.