| BackgroundClimacteric syndrome in premenopausal and postmenopausal women, estrogen level fluctuates or falls dramatically lead to autonomic nervous system dysfunction, neuropsychological symptoms associated with a group of syndromes. Clinical manifestations are hot flashes and sweating, upset, irritability, heart palpitation, dyshoria heat, headache, dizziness, tinnitus, insomnia, depression, anxiety and so on. These symptoms bring serious impact to their quality of life affect their health.2009 Hong Kong female population aged 40-55 years has been as high as one million, as the population group grows there will be more and more women suffering from the disease and increase demand for related medical services. With the improvement of community health knowledge, the new generation of Hong Kong perimenopausal women pay more attention to health and to pursuit superior quality of life. Because the vast clinical symptoms of climacteric syndrome, repeated illness, illness for a long time, the majority of patients caused serious physical and mental pressure, but also undermine the work of their productivities so that their family relationships and social lives have been adversely affected. Perimenopausal women's health is a major issue can not be ignored, it is a beam subject worth to study. Because the treatment of female climacteric syndrome by western medicine cause certain side effects, coupled with the medical model of change, the new concept of health, the amount of people not only pay more attention to the pursuit of life, but also the quality of life. Therefore, to find a safe and effective method for the prevention and treatment of this disease has important practical significance. Chinese medicine had been practiced for thousands of years, Chinese medicine treatment of gynecological diseases has unique characteristics and good clinical effects, acupuncture and Chinese medicine therapies to treat the disease not only has better clinical effect, but also with fewer side effects, and in a easier way. How to take the advantages of Chinese medicine for the application on the treatment for perimenopausal syndromes, to strengthen the role of Chinese medicine in Hong Kong health care system to contribute to women's health, to highlight the advantages of Chinese medicine on disease controlling for the improvement of the perimenopausal women's heath in the quality and quality of life, to help them easily across the perimenopause is a very interesting topic.ObjectiveTo observe acupuncture combined with Chinese medicine treatment for the type of kidney deficiency and stagnation in liver Qi perimenopausal syndrome clinical efficacy, and to compare of acupuncture combined with Chinese medicine treatment with pure Chinese medicine treatment, and the effects of two different treatment modalities, and perimenopausal syndrome patients on quality of life, to further explore the acupuncture treatment mechanism on perimenopausal syndrome. Hope that through this study, to find a safe and effective clinical treatment measures for curing the disease in the future, but also with Chinese characteristics therapies, and then to improve the patients'quality of life with perimenopausal syndrome in Hong Kong, to contribute and to promote traditional Chinese medicine development in Hong Kong and promote Chinese medical specialty to contribute to traditional Chinese medical industry.MethodsCollection of Pok Oi Hospital Chinese Medicine Clinic patients during the period of April -December 2010, whose ages between 45-55 years old, diagnosed as perimenopausal syndrome and kidney deficiency and stagnation in liver Qi type consistent with traditional Chinese medicine diagnosis, with a total of 63 cases studied, according to the principle of randomization, according to random number table to meet the inclusion criteria of the 63 cases of perimenopausal syndrome were divided into treatment group (acupuncture combined with traditional Chinese medicine group) 31 patients, in the control group (treated with traditional Chinese medicine) were 32 patients. Specific research methods of each group are:1.The treatment group(Acupuncture combined with Chinese medicine treatment):Acupuncture:Take two sets of acupuncture points:①:Baihui, Guanyuan, Qihai, Sanyinjiao (double), Taichong (double);②:Ganshu (double), Shen shu (double), Yanglingquan (double), Neiguan (double), Taixi (double). Methods of operation:each time take a group of selected points, two groups are used interchangeably. Needling every 10 minutes, let the needles stay for 30 minutes. Alternate use of two sets of points, every other day, stops acupuncture treatment during menstruation period, continuous treatment for two months.Chinese medicine:Gives the patients concentrated Chinese medicine powder which is made up of Liu Wei Di Huang Wan and Dan Zhi Xiao Yao San (10 grams of concentrated Liu Wei Di Huang Wan powder containing Chinese medicinal herbs: Rehmannia 24g, Chinese yam 12g, Cornus 12g, Poria 9g, Alisma 9g, Cortex Moutan 9g; 10 grams of concentrated Dan Zhi Xiao Yao San powder containing Chinese medicinal herbs:Radix Bupleuri 12g, Atractylodes 12g, Angelica 12g, White Peony Root 12g, Poria 12g, Cortex Moutan 10g, Gardenia 10g, Baked Licorice 6g. Ratio:Liu Wei Di Huang Wan:Danzhi Xiao Yao San 1:1,2 times a day orally, each time 10 grams (5 grams Liu Wei Di Huang mixed with 5 grams Dan Xiao Yao San), Continuous taking for two months.2. The control group (Chinese medicine treament):Gives the patients concentrated Chinese medicine powder which is made up of Liu Wei Di Huang Wan and Dan Zhi Xiao Yao San. Ratio:Liu Wei Di Huang Wan:Dan Zhi Xiao Yao San 1:1,2 times a day orally, each timelO grams (5 grams Liu Wei Di Huang mixed with 5 grams Dan Xiao Yao San), Continuous taking for two months.Before and after treatment in both groups from the clinical observation of the following aspects:(1) clinical symptom score using the modified Kupperman score scale, the scale is most extensive used for the evaluation of perimenopausal syndrome, the scale reflects the 13 symptoms associated with menopause syndrome, the performance of different systems, with a certain representation. (2) Determination of the main symptoms of perimenopausal syndrome changes:hot flushes and sweating, paresthesia, insomnia, irritability, depression, dizziness, fatigue, bone and joint pain, muscle pain, headache, heart palpitation, feeling of ants crawling skin, the sense of painful intercourse, urinary symptoms, take assessments by using the modified Kupperman score scale, in the treatment before, during (1 month after treatment)and after treatment (2 months after treatment), and calculate the value of its improvements, calculate the KI improvement value. (3) MOS SF-36 Health Survey (Chinese version), which are widely used in clinical scale has good reliability, validity and representativeness of the main outcomes as quality of life indicators. Among them, physical health (PF), physical role function (RP), bodily pain (BP), general health (GH), vitality (VT), social function (SF), emotional role functioning (RE), mental health (MH),8 dimensions, each dimension contains a number of issues, a total of 36 items. (4) Safety testing:before and after the treatment examine blood, urine, liver and kidney function, ECG, etc., and the adverse reactions observed during the treatment will be recorded, safety course evaluation form will be completed after treatment. Two groups of patients before treatment,1 month and 2 months after treatment were carried out a questionnaire rating. All data entry into computer and the SPSS13.0 the statistical software is used for data processing and analysis of statistical data, draw conclusions.ResultsDuring the experiment, there has no lost or out of the control cases, specific treatment results were as follows:1. Before treatment two groups of patients in age, duration and other aspects of syndromes between the two groups of basic information, after examination by Riddit-test (P> 0.05) no significant difference, suggesting that two sets of samples from the same population, had a good comparability between.2.The clinical symptoms of perimenopausal syndrome efficacy evaluation(1) modified Kupperman (KI) scoreBefore treatment, the overall total score clinical symptoms between the two groups showed no difference between KI index (P>0.05), shows that basic information between the two groups were comparable.①After 1 month and 2 months treatment, the comparison of treatment group KI index of its own before and after, there was significant difference (P<0.01), after 1 month and 2 months treatment, the comparison of control group KI index of its own before and after, there was significant difference (P<0.01), suggesting that two treatment methods are effective, proven both methods can substantially reduce the KI score, effective relieving the symptoms of menopausal syndrome such as hot flashed and sweating, paresthesia, insomnia, irritability, depression, dizziness, Fatigue, bone and joint pain, muscle pain, headache, heart palpitation, feeling of ants crawling skin, the sense of painful intercourse, urinary symptoms, and treatment effects of two months was significantly better than the effect of one month treatment.②Comparison between the two groups after treatment, the improvement value of KI index were significantly different (P<0.05), proofing that the treatment group effect of acupuncture combined with Chinese medicine as a whole better than the control group with pure Chinese medicine.③Before treatment, the mean KI score in both groups are closed to 25 points,1 month after treatment, the treatment group mean KI index score dropped from 25.90±6.91 to 15.52±5.09; the control group mean KI index score dropped from 24.25±6.21 to 15.69±4.41; The results shown that the KI index of the two groups are significant decline in two treatment methods can prove effective in improving physical fitness in patients with the type of kidney deficiency and liver Qi stagnation perimenopausal syndrome symptoms. Treatment for 2 consecutive months, the two groups KI index continued to decline, suggesting that there is continuous treatment effect for two months to strengthen the role of efficacy.The comparison of KI to improvement value between two groups shown significant differences, proving that acupuncture combined with Chinese medicine treatment is effective than pure Chinese medicine treatment. Acupuncture combined with prompt treatment group were significantly better than pure Chinese medicine, acupuncture combined with Chinese medicine to treat perimenopausal syndrome is more effective.(2) Symptoms Comparative evaluation of efficacy between the two groups Clinical analysis of the symptoms come to the following summary:①treatment group and control group compared within groups:1 month treatment and 2 months treatment of various symptoms in both groups shown effective improvement (P <0.05).②treatment group and control group comparison between two groups: 1 month treatment and 2 months treatment the value of KI improvement were no difference in symptoms:hot flashes and sweating, fatigue, the sense of painful intercourse; the value of KI improvement comparison between groups shown significant difference in those symptoms:insomnia, irritability, depression, dizziness, bone and joint pain, muscle pain, headache, heart palpitation, feeling of ants crawling skin, urinary symptoms, indicating that the treatment group has a better curing effect than the control group in the nervous system, psychological and pain symptoms.1 month after treatment, KI improvement values comparison shown difference in two groups in paresthesia symptom (P=0.016), proving that the treated group had a more rapid and effective effect in relieving that symptom, but the treatment effect is almost the same after 2 months treatment in both groups, suggesting a slower onset of efficacy of traditional Chinese medicine.1. The comparison of the quality of life before and after treatment between two groupsBefore treatments, comparison between the two groups, SF-36 Health Survey score in 8 dimensions were no significant differences (P> 0.05), shown that they were comparable between groups.①After treatments,8 dimensions were significantly improved (P<0.01), and in terms of comprehensive integration also significantly increased (P<0.01), the curing effect in treatment group(acupuncture combined with Chinese medicine) that can improve their quality of life;②After treatment, in the control group,8 dimensions were significantly improved (P<0.01), and in terms of comprehensive integration also significantly increased (P<0.01), proving that Chinese medicine treatment of nourishing kidney and dredging liver Qi method can effectively improve their quality of life.③governance between two groups after treatment, in addition to physical health (PF), physical role function (RP), mental health (MH) had no significant difference (P>0.05), but in bodily pain (BP), general health (GH), vitality (VT), emotional role functioning (RE) and other aspects of comprehensive integration between two groups, the results were statistically significant differences (P<0.01). Social function (SF) between two groups, resulting in a statistically different (P<0.05).④Table 18 results shown that the use of acupuncture combined with Chinese medicine treatment group, improving patients quality of life in the role of five aspects, such as bodily pain (BP), general health (GH), vitality (VT), emotional role functioning (RE), social function (SF), and its efficacy is better than using pure traditional Chinese medicine group; but two groups in improving physical health (PF), physical role function (RP), mental health (MH), the degree of effectiveness had no significant difference, indicating that two groups in terms of improving those aspects were of similar efficacy.2. Comparison of effectiveness in two groups after treatmentThe constituent ratio of efficacy between the two groups were compared by ridit test after the treatments, shown significant differences (P<0.05), indicating the use of acupuncture combined with Chinese medicine treatment, significantly better than treatment with medicine alone in healing menopausal syndrome patients. The total effective rate was 90.3% in treatment group, while the control group, the total effective rate was 75.0%, total effective comparison between two groups, statistical results showed no significant difference between the two groups (P> 0.05), that confining the use of acupuncture combined with Chinese medicine treatment on menopausal syndrome, its overall efficacy were similar to the effect with pure Chinese medicine treatment group.5. The comparison of adverse reactions between two groups after treatmentThroughout the study, no significant adverse reactions found in both treatment group and control groups, so the two groups belong to a safety level.ConclusionClinically proven to stimulate acupuncture points through the meridians to regulate organs function, making the body function in a better way, adjusting to improve neurological function, sedation, analgesia, etc. so that effective control of clinical symptoms and improvement in pain and symptom relief in patients with physical, life and working ability, emotional stability, social enhancements, the overall health improved significantly. Chinese medicine treatment, the use of Liu Wei Di Huang Wan with Dan Zhi Xiao Yao San together regulating the body, in multi-system, multi-target way. This Chinese medical formula had good therapeutic effect on the type of kidney deficiency and liver Qi stagnation perimenopausal syndrome which caused a series of irritability, dizziness, tinnitus, dry eyes, hot flashes, and sweating, dry mouth, bittery mouth, upset, insomnia and other symptoms. The clinical results proven the effect of acupuncture combined with Chinese medicine on perimenopausal syndrome was better than that of Chinese medicine alone, it is worth promoting in clinical use. |
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