Analysis Of Contemporary Research Literature On Acupuncture And Moxibustion As Treatment For Polycystic Ovary Syndrome

ObjectiveTo analyze the metrological characteristics and overall quality of empirical research as documented in modern Chinese periodical literature on using acupuncture for treating polycystic ovary syndrome (PCOS). To identify the principles in acupint selections, the curative effect of acupuncture and moxibustion treatment of PCOS and the current research focus areas in the literature.MethodsWe systematically retrieved the literature on using acupuncture for treating PCOS from Chinese journal full-text databases (CNKI), Wanfang Data Knowledge Service (WanFangDate), VIP journal integration platform (VIP) and Chinese Biomedical Literature Database (CBM) and established a database on the basis of the literature. Then we analyzed the metrological characteristics and the patterns of acupoint selections in the literature through NoteExpress, evaluated the quality, and total effective rate, curative effect of acupuncture, and safety of using acupuncture for treating PCOS through STRICTA and Reviewmanager 5.2, created keyword matrix for subsequent data retrieval using Bibexcel, and identified the current research trends through cluster analysis in SPSS 22.0.ResultsThe database that the current research analysis is established upon includes 215 references, dated back to 1988 and mostly from 2014 with an annual average coverage of 7.9. The references were contributed by authors from 25 provinces, the top five being Guangdong, Shanghai, Shandong, Hei Long Jiang, and Jiangsu. The references originated from 78 journals, the top five being the Journal of Shanghai Acupuncture, Chinese Acupuncture and Moxibustion, Acupuncture Clinical Magazine, Modern Distance Education of Chinese Medicine in China, and the Journal of Liaoning Traditional Chinese Medicine. The literature mostly was mostly built on clinical research involving a control group conducted by 453 researchers with 621 signed names, the top two being Yin Shi and Hongxia Ma. A total of 420 keywords were presented in the literature with a total keyword occurrence rate of 1049 and an occurrence rate per article of 4.88; no keywords were provided in four research articles. The most frequently used keywords include "polycystic ovary syndrome", "sex hormones", "acupuncture", "needle medicine and used", "insulin resistance", "clinical research", "acupuncture point bury line", "ovulation obstacle", and "cupping". The database involves 117 author affiliations, including 18 universities,95 hospitals,2 research institutes,2 private clinics. Amongst these organizations, Guangzhou University of Chinese Medicine, Nanjing University of Chinese Medicine, Shandong University of Chinese Medicine, Heilongjiang University of Chinese Medicine, Acupuncture and Meridian Research Institute, Beijing University of Chinese Medicine in Shanghai, and The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine have published more than 4 research articles. The organizations contributing the top five most literature to the database are respectively Guangzhou University of Chinese Medicine, Nanjing University of Chinese Medicine, Shandong University of Chinese Medicine, Heilongjiang University of Chinese Medicine, and Shanghai Institute of Acupuncture and Meridian.The database covers 11 types of acupuncture and moxibustion therapies including acupuncture, electric acupuncture, moxibustion, the needle, ear pressure, temperature, acupuncture point bury a line, abdomen needle, wen jiu, separated moxibustion, thunder fire moxibustion, and so on. The therapies investigated more than five times in the database include acupuncture+Chinese medicine, acupuncture, acupoint burying line, acupuncture point bury line+ traditional Chinese medicine, acupuncture, moxibustion, electric acupuncture, acupuncture plus moxibustion plus Chinese medicine and acupuncture plus western medicine, and abdominal needle. The database covers 148 acupuncture prescriptions involving a total of 61 acupuncture points with each prescription involving 2-15 acupoints. The 61 acupoints include 3 external points (uterus, ovaries, the diagnosis of shu),58 acupoints mentioned for 1002 times, with an average of 16.43 times per acupoint. The top ten specific acupoints (used for 560 times taking up 55.89% of the total usage) are respectively guan yuan, san yin jiao, qi hai, zhong ji, tian shu, zhong yuan, kidney, feng long, spleen, and xue hai. The database mentions the use of 12 meridians with the top five frequently mentioned ones being ren meridian, the meridian of spleen located on foot, the meridian of yangming stomach located on foot, the meridian of bladder located on foot, and the merdian of kidney located on foot. A total of 345 patterns were obtained from the database regarding the intra-use of the 61 acupoints involving acupoints of san yin jiao, guan yuan, uterus, zhong ji, qi hai, and zhong yuan. The top ten combined use patterns of acupoints are san yin jiaoâ†' guan yuan, uterusâ†' guan yuan, zhongjieâ†'guan yuan, guan yuanâ†'san yin jiao, uterineâ†'san yin jiao, zhong jiâ†' san yin jiao, guan yuanâ†' qi hai, san yin jiaoâ†' qi hai, zhong yuanâ†' qi hai, guan yuanâ†' uterus.Twenty one references from the database were used for further meta-analysis. The 21 references included 9 high-quality ones (2 research articles rated with 5 points,3 articles with 4 points) and 12 low-quality ones (4 articles rated with 3 points,11 articles with 2 points, and one article with 0 point), as evaluated by the Jadad rating scale (1 to 3 points regarded as low quality,4-7 points as high quality). As shown by the meta-analysis, the use of acupuncture in combination with western medicine is statistically more effective than the use of western medicine [RR= 1.20,95% CI (1.09,1.09), P＜ 0.01). In terms of cure rate, the use of acupuncture in combination with western medicine is statistically higher than the use of western medicine [RR = 1.68,95% CI (1.21,1.21), P＜0.05). However, in terms of pregnancy rate, the use of acupuncture in combination with western medicine is not statistically different from the use of western medicine (RR= 1.03,95% CI (0.74,0.74), P＞ 0.05).A total of 211 references were used for keyword cluster analysis. The total frequency of keyword usage is 908, with the 7 keywords being used very frequently with an accumulative occurrence rate of 424. Keywords such as "polycystic ovary syndrome", "acupuncture", "acupuncture point bury line", "obesity" and "insulin resistance" tend to cluster together. "Metformin" and "adolescent" and "taie 35", "clinical efficacy" tend to co-occur; "Sex hormones", "insulin" and "cupping", "g’Finn", "Meta-analysis", "acupuncture", "synthesis", "san yin jiao", "medicine and needle", "Chinese medicine therapy" "abdominal needle", "ovulation obstacle", "moxibustion", "Chinese medicine", "high androgen hematic disease", "clinical observation", "the combination of acupuncture with medicine", "pregnancy rate", "clinical research" are usually used together. ConclusionThe contemporary literature on the acupuncture treatment of PCOS was mostly contributed by domestic universities and graduate students, most of whom are from Guangdong Province. The key journals publishing the relevant research include Journal of Shanghai Acupuncture, Chinese Acupuncture and Moxibustion, Acupuncture Clinical Magazine, Chinese Modern Distance Education of Chinese Medicine, and Journal of Liaoning Traditional Chinese Medicine. The most influential researchers in the field including Yin Shi and Hongxia Ma. Polycystic ovary syndrome has been expressed with "polycystic ovary syndrome", "polycystic ovary", "obese polycystic ovary syndrome, " and so on, suggests the use of keywords should be regulated.Acupuncture treatment of PCOS usually involves the selection of merdians such as ren meridian, the merdian of spleen located on the foot, the merdian of stomach on the foot, the merdian of bladder on the foot, and the merdian of kidney on the foot, the selection of acupoints such as guan yuan, kidney, qi hai, zhong ji, san yin jiao, and so on with prior attention given to the treatment of kidney and liver and the removal of blood stasis and internal humidity. The most commonly adopted treatment method is the combined use of Chinese medicine acupuncture and moxibustion on acupoints and merdians such as san yin jiao, guan yuan, uterus, zhong ji, qi hai, zhong yuan, and the ren merdian and merdian of spleen.The overall efficacy of acupuncture combined with medication in treating PCOS is superior to the pure use of medication; acupuncture has an advantage in promoting ovulation and fertility, and is a safe and effective method for the treatment of PCOS.Three major research trends have been identified in the contemporary clinical research on using acupuncture for treating PCOS include the common symptoms of PCOS and the highly frequent use of acupuncture for treating PCOS, PCOS being a high-risk disease for adolescents and the use of western medicine treatment for PCOS, and the commonly used acupuncture methods for treating PCOS.