Clinical Study Of The Relationship Between Chinese Medicine Constitution And Postpartum Hypogalactia And The Treatment Of Chinese Medicine

Objectives1.To analyze the distribution regularity of TCM constitution type by comparing the distribution frequency from two populations of normal lactation and postpartum hypogalactia via clinical epidemiology and to explore the relationship between postpartum hypogalactia and constitution types. Further study the relationship between constitution of postpartum hypogalactia and TCM syndrome type, for provide new ideas and methods for the prevention and treatment of postpartum hypogalactia.2. By comparing the differences of serum prolactin two populations of normal lactation and postpartum hypogalactia, to investigate the relationship between serum prolactin and postpartum milk secretion.3. To explore the intervention effect of Shu gan Tong luo method on postpartum hypogalactia of liver depression and qi stagnation syndrome from the influence of serum prolactin(PRL) and the clinical efficacy, TCM syndrome curative effect and so on, to provide clinical and theoretical basis for the treatment of postpartum hypogalactia and the development and application of Traditional Chinese Medicine.Methods1. Selected in-patients and out-patients of postpartum hypogalactia from First Affiliated Hospital of the Guangzhou University of Traditonal Chinese Medicine from September of2011to October of2013in400cases as case group, chose another normal lactation in400cases as control group, using 《TCM constitution questionaire》 by reseacher to analyze the constitution types and explore which type can impact the incidence of postpartum hypogalactia by Logistic regression analysis. Analyzed TCM syndrome in case gruop by collecting clinical datas and the correspondence analysis investigated the relationship between constitution types and TCM syndrome types.2. Selected randomly100patients of liver depression and qi stagnation syndrome from400cases of postpartum hypogalactia as case group,100patients chosen randomly from400cases normal lactation patients as control group. We compared difference of serum PRL of the two groups to explore the relationship between serum PRL and postpartum milk secretion.3.100patients with liver depression and qi stagnation syndrome of postpartum hypogalactia were divided randomly into test group which was treated with Shu gan Tong luo method (with Xia Ru Yong Quan powder)and control group which was treated with Shu gan method(with Xiao Yao powder) with50cases in each group. PRL in serum were tested before and after the treatment of traditional Chinese medicine of the two groups. Compare the severity of disease, supplementing lactating quantity, breast fullness, supplementing lactating quantity, TCM syndrome integral, change of reducing rate of the two groups, in order to assess the intervention effect of Shu gan Tong luo method on postpartum hypogalactia of liver depression and qi stagnation syndrome.Results1.It was no significant difference (P>0.05) by statistically comparing age, native place, nationality, education, occupation, parity, mode of delivery, gestational age, newborn sex, neonatal weight from two populations of normal lactation and postpartum hypogalactia with400cases in each group.2. In400cases of normal lactation, constitution of yin-yang harmony were153cases, accounting for38.25%of total patients. The8kinds of biased constitution accounted for61.75%, accordingly from4.00%to10.75%; In400cases of postpartum hypogalactia, constitution of yin-yang harmony were66cases, accounting for only16.50%. The8kinds of biased constitution accounted for83.50%, the constitution of yin deficiency was the most, which acounted for19.00%; constitution of qi deficiency, constitution of qi stagnation accounted for15.00%and13.00%respectively. The difference of the constitution constituent ratio between these two groups was statistical significance (P<0.05).Comparison of the distribution of9kinds of constitution in case group and control group, distribution of constitution of yin-yang harmony, constitution of yin deficiency, the constitution of qi deficiency and constitution of qi stagnation was significantly different (P<0.05)Single-factor non-conditional Logistic regression of constitution types of postpartum hypogalactia showed that the corresponding P value of Constitution of yin-yang harmony, constitution of qi deficiency, constitution of yin deficiency and constitution of qi stagnation were less than0.05, there were statistical significance.Logistic regression equation, Y=-0.014×constant-0.827Xconstitution of yin-yang harmony+0.479Xconstitution of qi deficiency+0.665X constitution of yin deficiency+0.874Xconstitution of qi stagnation. The constitution of yin-yang harmony was the protection of constitution by OR value of0.473. The constitutions of yin deficiency, qi deficiency and qi stagnation were the risk constitutions by the corresponding OR value of1.664,1.926and2.396respectively. We could infer that constitution of qi stagnation have greatest impact on postpartum hypogalactia according to the value of OR sequence.Area under the ROC curve of logistic regression equation was0.665,95%CI:0.617-0.693, there was statistical significance(P<0.05), which shows that the regression equation has good performance test.3. In400cases of postpartum hypogalactia of case group, qi and blood deficiency syndrome was132cases, accounting for33.00%of total patients; Liver depression and qi stagnation syndrome was188cases accounting for47.00%, it is the most common; Phlegm stagnation syndrome was80cases, accounting for20.00%.Correspondence analysis of the postpartum hypogalactia patient constitution and TCM syndrome type suggested that there was a corresponding relationship between the constitution of qi deficiency, constitution of yang deficiency and qi and blood deficiency syndrome showing that these two constitutions people were more prone to form qi and blood deficiency syndrome than other groups; So there was a corresponding relationship between constitution of qi stagnation, constitution of yin deficiency, constituton of blood stasis and liver depression and qi stagnation syndrome, which illustrate that these three constitutions people were more prone to form liver depression and qi stagnation syndrome than other groups; There was a corresponding relationship between constitution of damp heat, constitution of phlegm dampness, allergic constitution and stagnation of phlegm syndrome, which pointed out that these three constitutions people are more prone to form stagnation of phlegm syndrome than other groups.4. Comparison of serum level of PRL of the two groups from100cases (case group)of postpartum hypogalactia patients of liver depression and qi stagnation syndrome before intervention of traditional chinese medicine and100cases (control group) of normal lactation patients:the serum level of PRL of control group was significantly higher than that of case group(P<0.05).There was no significant difference in the level of serum PRL between the test group and control group before the Chinese medicine treatment (P>0.05).The level of serum PRL of test group was significantly higher than that of control group after the Chinese medicine treatment (P<0.05).There was significant difference of the level of serum PRL before and after the Chinese medicine treatment in test group(P<0.05).There was no significant difference of the level of serum PRL before and after the Chinese medicine treatment in control group(P>0.05).5. There was no significant difference of the severity of disease, breast fullness, supplementing lactating quantity and TCM syndrome integral between test group and control group before Chinese medicine treatment(P>0.05).Compared with test group and control group after treatment with the traditional Chinese medicine, there were significant differences.After the treatment, the severity of disease reduced, breast fullness increased, supplementing lactating quantity are decreased, TCM syndrome integral cut down, reducing rate raised and the efficacy of TCM and clinical curative effect improved (P<0.05).Comparison of curative effect before and after intervention of traditional Chinese medicine in test group, after Chinese medicine treatment the severity of disease reduced, breast fullness increased, supplementing lactating quantity decreased, TCM syndrome integral cut down, the differences were statistical significance(P<0.05).Comparison of curative effect before and after intervention of traditional Chinese medicine in control group, after Chinese medicine treatment the severity of disease reduced, breast fullness increased, supplementing lactating quantity decreased, TCM syndrome integral cut down, the differences were statistical significance(P<0.05).6. Safety evaluation:there were no side effects and adverse reactions for the maternal and infants after taking traditional Chinese medicine in the test group and control group.Conclusions1. There is a close relationship between the TCM constitution types and postpartum hypogalactia. From the perspective of the constitution of traditional Chinese medicine, constitutions of yin deficiency, qi deficiency and qi stagnation are risk constitutions for postpartum hypogalactia and the constituton of yin-yang harmony is the protection of constitution. It shows that constitution evaluation of pregnant women in perinatal health care work should carry out, early recognition of biased physique and active care, most likely to prevent or reduce the occurrence of postpartum hypogalactia, playing an dynamic role in the prevention and treatment of disease, in order to better practice the concept of TCM preventive treatment of disease.There is corresponding relationship between TCM constitution and TCM syndrome types of postpartum hypogalactia. Clinical attention should be paid to the internal connection between the different constitutions and syndrome and also the differences of responses to drugs and so on, according to the type of constitution to adjust the movement of yin and yang, the unbalanced inclination, embody the principle treatment of the "people-oriented","cure for the disease".2. The level of serum PRL of postpartum hypogalactia patient is lower than that of normal postpartum milk lactation person suggesting that serum PRL is closely related to postpartum milk secretion.3.Shu gan Tong luo method can promote the postpartum milk secretion for postpartum hypogalactia of liver depression and qi stagnation syndrome, has good clinical efficacy and TCM syndrome curative effect, improve the rate of breast feeding and promote maternal and child health, provide the clinical and theoretical basis for the treatment of postpartum hypogalactia of the liver depression and qi stagnation syndrome and development and application of traditional Chinese medicine.