Clinical Study On Treatment Of Polycystic Ovary Syndrome By Acupuncture And Liver - Qing

1. Clinical investigation on PCOS based on SCL-90 scaleObjectiveThrough SCL-90 questionnaire of the patients of oligomenorrhea/infertility in Polycystic ovary syndrome (PCOS), it is to explore the psychological healthy problem of the patients and attempt to discover the correlation of PCOS with the liver dysfunction of maintaining the free flow of qi and dysfunction of qi activity.MethodsThe questionnaire investigation was adopted and the subjects were from the clinic of Acupuncture and Moxibustion Hospital, China Academy of Chinese Medical Sciences, manifested as oligomenorrhea/infertility, met with PCOS diagnostic criteria recommended by Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group in 2003, visited from June 2012 to September 2014.The questionnaire included two sections for the patients and physicians separately. The research staffs distributed the section for the patients, including the general factors and Symptom Check List 90 (SCL-90). The patients were required to fill them up and the questionnaires were collected on the site. Ninety items are included in SCL-90, with 9 factors involved, named somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, aggression, phobia, paranoid ideation and psychoticism. The recorders accomplished the section for the physicians in the questionnaire, for the pattern/syndrome differentiation in TCM.Results1) Totally 143 pieces of questionnaire were distributed and 140 pieces of them were collected, the collection rate was 97.9%. The average age of the subjects was (28.09 ±4.07) years old, the average duration of irregular menstruation was (7.71 ± 4.90) years. Of the subjects,91 cases were married, accounting for 65.0% and 90 cases were of the desire of pregnancy, accounting for 64.3%.2) The scores of eight factors, named somatization, obsessive-compulsive, depression, anxiety, aggression, phobia, paranoid ideation and psychoticism, were all significantly higher than those in the domestic standard model group (P<0.01). The total score of the subjects, GSIt> 153 in SCL-90 and the subjects with obvious psychological problem accounted for 41.43% of the total numbers.3) In the research, the most PCOS patients were differentiated as heat stagnation in liver meridian, accounting for 36.4%, followed by retention of phlegm and damp for 25.0%, kidney deficiency for 22.9%, qi and blood stagnation for 15.7%.Conclusion1) PCOS patients complicated with oligomenorrhea/infertility have apparent psychological healthy problem.2) Of PCOS patients mainly complained as oligomenorrhea/infertility, the percentage of the cases differentiated as heat stagnation in liver meridian is the highest.3) It is deduced that the liver dysfunction of maintaining the free flow of qi and dysfunction of qi activity in the whole body is the essential pathogenesis of PCOS, in which, both physical and mental disorders are involved.2. Clinical observation of PCOS treated with acupuncture for relieving liver stagnation and regulating qi activityObjective1) To discuss the clinical efficacy of acupuncture for relieving liver stagnation and regulating qi activity and the effect on the psychological health in the treatment of PCOS through the clinical controlled trial in comparison with diane-35.2) To dig the advantages of acupuncture and explore the clinical approach of it to the co-regulation of physical and mental conditions in the treatment of PCOS.MethodsSeventy-two cases were collected from the clinic of Acupuncture and Moxibustion Hospital, China Academy of Chinese Medical Sciences, aged from 18 to 35 years, with the chief complain of oligomenorrhea/infertility, met with PCOS diagnostic criteria recommended by Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group in 2003, the score of liver stagnation> 3 points, and in accordance with the other research standards. The cases were randomized into a western medicine group and an acupuncture group,36 cases in each one.In the western medicine group, diane-35 was prescribed for oral administration, starting on the 5th day of menstruation, continuously for 21 days and totally for 3 months. In the acupuncture group, the acupoint prescription was formulated based on relieving liver stagnation and regulating qi activity. The acupoints included Shanzhong (CV17), Qimen (LR14, bilateral), Ganshu (BL18, bilateral), Zhongwan (CV12), Tianshu (ST25, bilateral), Guanyuan (CV4, bilateral), Zigong (EX-CA1, bilateral), Sanyinjiao (SP6, bilateral), Zusanli (ST36, bilateral) and Taichong (LE3, bilateral). After arrival of qi, the electric stimulation was attached to Zhongwan (CV12) and Guanyuan (CV4), Tianshu (ST25) and Zigong (EX-CA1) on the same side, with continuous wave, at 20Hz, tolerable intensity, for 30min. The treatment was given three times a week, continuously for 3 months; and interrupted during menstruation.At the end of treatment, the following indexes were observed and detected in the patients of the two groups.1) TCM symptom score:according to the grading and quantification standard of TCM symptom score of irregular menstruation, the score was recorded by the specialist.2) General surveying index:the body height, body weight, waist line and hip line were measured. BMI and the waist-to-hip ratio were calculated by the specialist.3) Serum gonadal hormone levels:the fasting venous blood collected on the 2nd-4th days of menstrual period for the determination of gonadal hormone levels (FSH, LF, T, E2, P and PRL) and calculation of LH/FSH.4) Acne score:Rosenfield scoring method adopted.5) Hirsutism score:F-G scoring method adopted.6) Psychological health score:SCL-90 was adopted and responded by the, patients themselves.The 3-month follow-up was conducted after treatment to record the recovery of menstruation and ovulation in the patients of the two groups.Results1) Totally,33 cases were accomplished the trial and 3 cases were dropped in the western medicine group and 35 cases were accomplished the trial and 1 case was dropped in the acupuncture group. The average age of the patients was (28.16 ± 3.76) years old, the average duration of irregular menstruation was (7.26± 3.83) years and the average duration of sickness was (2.88±1.76) years. The baseline data were not different significantly before the treatment in comparison of the two groups (P<0.05).2) After treatment, the symptom scores were reduced significantly as compared with those before treatment in the western medicine group (P=0.000) and the acupuncture group (P<0.000) separately. The symptom scores after treatment in the acupuncture group were reduced more significantly as compared with those in the western medicine (P<0.004).3) After treatment, the body weight (P=0.016), BMI (P=0.004), waist circumference (P=0.035) and hip circumference (P=0.000) in the acupuncture group were lower significantly than those in the western medicine.4) After treatment, the values of serum LH, T and LF/FSH were reduced significantly as compared with those before treatment in the same group (all P=0.000). The hirsutism score was not different significantly before and after treatment in the comparison between the two groups (P>0.05).5) After treatment, the acne score was reduced significantly in the western medicine group and the acupuncture group as compared with that before treatment in the corresponding group separately (both P=0.000). The difference in the hirutism score was not significant in comparison before and after treatment in both groups (P>0.05).6) After treatment, the total score of SCL-90 was reduced significantly as compared with that before treatment in the acupuncture group (P=0.006), significantly lower than that in the western medicine group (P=0.021). The scores of somatization, interpersonal sensitivity, depression, anxiety and aggression were lower significantly than those before treatment in the acupuncture group (P<0.05). The scores of somatization, interpersonal sensitivity, depression, anxiety, aggression and phobia in the acupuncture group were lower significantly than those in the western medicine group after treatment (P<0.05).7) The total effective rate was 81.8% in the western medicine group and was 88.6% in the acupuncture group, without significant difference in comparison (P=0.308). The differences were not significant in the recovery rate of menstruation and ovulatory rate between the two groups (P>0.05).Conclusion1) Acupuncture for relieving liver stagnation and regulating qi activity achieves the similar efficacy in the total effective rate, the recovery rate of menstruation and ovulatory rate as compared with diane-35.2) Acupuncture for relieving liver stagnation and regulating qi activity and the medication with diane-35 all regulate the serum gonadal hormone concentrations and effectively relieves hyperandrogenism.3) Acupuncture for relieving liver stagnation and regulating qi activity relieves TCM symptoms, regulates body weight, BMI and the other metabolic indexes. The effects of acupuncture for relieving liver stagnation and regulating qi activity are better than those of diane-35.4) Acupuncture for relieving liver stagnation and regulating qi activity regulates both the physical and the mental conditions, reduces SCL-90 scores and improves the psychological health of PCOS patients. The effects of it are better than those of diane-35.