| Menopause is a transitional period that human body physiology transfers from the middle age to the old age, as well as a milestone that physiological function of human body tends to senescence from prosperous state.The women's climacteric syndrome is a cluster of clinical symptoms taken place at women menopause period with the functional disturbance of vegetative nerve which is manifested as hectic fever, flushed complexion, irregular menstruation, sweating, unsteady mood, etc. As a result, these will affect human health and work. Therefore, it is very important to make women pass through the menopause steadily, avoid or alleviate the occurrence of menopause syndrome, prevent and treat disease in senile period, enhance the quality of life for the old-age society in the near future.The following three aspects are concerned in this dissertation to discuss the climacteric syndrome systematically in the field of acupuncture and moxibustion of traditional Chinese medicine. 1 Literature researchOn reviewing the knowledge of disease definition, pathological mechanism, animal model of climacteric syndrome in modern medical science, the author pointed out that estrogen were closely related to women's climacteric syndrome. The estrogen level lowered excessively, which led to the dysfunction of hypothalamic-pituitary-ovarian or adrenal glands axis. As a result, it would further cause climacteric syndrome. As far as its treatment is concerned, at present, modern medical science adopts mainly the treatment according to symptoms and the estrogen substituting treatment. Although curative effect of estrogensubstituting treatment is confirmed clinically, it causes adverse reactions. Therefore, there are different opinions on the estrogen substituting treatment and its safety.On reviewing the etiology and pathogenesis, treatment selection on syndrome differentiation of climacteric syndrome in TCM, the author pointed out that the history of the cognition of physiology and pathology for the premenopause, climacteric, postmenopause stage in TCM is very long. Not a few literatures are relative to climacteric syndrome, while none of them is specialized in climacteric syndrome. The symptoms are included in the following chapters, such as "irregular menstruation", "hysteria", "lily disease", "melancholia", "syndromes before and after menopause", etc. Acu-bustion has a desirable effect on climacteric syndrome, especially, regulating its functions of the reproductive endocrine and vegetative nerve system.Based on the technique of acupuncture and moxibustion, the therapy of catgut embedding in points was developed by utilizing modern science and technology methods creatively. Catgut embedding in points has a desirable effect on climacteric syndrome in clinic. In addition, my directors have a great experience on research of catgut embedding therapyOn reviewing the cognition of climacteric syndrome in both Traditional Chinese Medicine and modern medical science, the author pointed out that there is stable and forceful theoretic foundation and significant clinical meaning to probing into the effect of catgut embedding in points for the treatment of women's climacteric syndrome and its reproductive endocrine mechanism. 2 Clinical studyPurpose: Clinical study is to investigate the curative effect of catgut embedding in points on women's climacteric syndrome and its influence on the reproductive endocrine of women's postmenopause, bone metabolism, and probe the possible effect mechanism from the angle of hypothalamic-pituitary-gonad axis.Methods: 65 cases of postmenopausal women aged from 50 to 60 were selected on certain diagnostic standard, and were randomly assigned to treatment group (n=33) and control group (n=32). Treatment group was treated by catgut embedding in points once 2 weeks, 3 months in all, while control group was dealt with fufuchun 2 capsules once per day, 3 months in all. The main acupoints choosen in treatment group were as follows: Guanyuan(CV4), bilateral Sanyinjiao(SP6) and bilateral Shenshu( BL23), modified according to syndrome differentiation. Three months made up an observing therapeutic course, measured each index of both groups before and after treatment respectively. The indexes were as follows:(1) The effect of catgut embedding in points on peripheral serum follicle stimulatinghormone(FSH),luteinizing hormone(LH),estradiol(E2),testosterone(T) osteocalcin(BGP), parathyroid hormone(PTH), calcitonin(CT), alkaline phosphatase(AKP) levels were observed before and after treatment respectively. The serum FSH, LH, E2, T, BGP, PTH and CT levels were estimated by radioimmunoassay (RIA), and serum AKP, and relational indexes of liver and kidney with the blood from elbow vein.(2) The improved method of Kuppermann grade point was adopted to estimate symptoms and curative effect.(3) The quality of life was investigated with MOS SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey) before and after treatment.Results:(1) There was no significant difference between treatment group and control group in the common conditions (P>0.05), such as age, culture level of structure, physical state, etc.(2) There was no significant difference between treatment group and control group in the Kuppermann grades(MI index) before the treatment(P>0.05).The main symptoms of both groups were improved greatly and Kuppermann grades decreased significantly after treatment. Among them, the effect of the treatment group on the bone joint muscle aches of the patients was much better than that of the control group;the efficacy of control group on the vagina dry ache was superior to that of the treatment group.(3) There was no significant difference between treatment group and control group in their efficacy after treatment(P>0.05). The shorter the course of the disease and the milder the symptoms were, the better the curative effect was.(4) There was no significant difference between treatment group and control group in the quality of life(QOL) score before treatment(P>0.05). The QOL score of both groups were lifted remarkably after treatment (P<0.05) , except Social function (SF) and Role physical (RP) of the treatment group and Role emotion (RE) of the control group. Among them, the improving effect of the treatment group on Bodily pain (BP)and Mental Health (MH) were much better than those of the control group (P^O.01).(5) The levels of serum FSH and LH postmenopausal women were higher than that of normal women's, while serum E2 was far lower than that of normal women's, and declined continuously by the increase of menopause years.(6) There was no significant difference between treatment group and control group in the level of serum E2> Tn FSHn LH before treatment(P>0.05). After treatment, the levels of serum E2 and T of both groups were increased, while the efficacy of treatment group on the serum E2 was more significant than that of the control group(P<0.05), the efficacy of treatment group on the serum Twas no significant(P>0.05);the levels serum FSH, LHof both groups were reduced significantly(P<0.05), especially, those of treatment group.(7) There was no significant difference between treatment group and control group in the level of serum BGP, CT ,PTH and AKP before treatment(P>0.05). The amount of serum BGP, CT PTH and AKP of both groups were decreased significantly after treatment (P<0.05), especially, the change of PTH (P<0.001). There was no significant difference in the AKP level between pre-treatment and post-treatment.(8) The investigation of adverse reaction in recentness: redness and swelling in the Sanyinjiao (SP 6) occurred in one case of treatment group (3.03%);there were 8 cases (25%) suffering from nausea and lethargy, 7 cases (21.9%) suffered from breast distention during medication. The function of the liver and kidney of both groups were normal before and after treatment. The occurrence rate of adverse reaction in the control group was higher than that of the treatment group (P<0.01).Conclusion:(1) Catgut embedding in points has an obvious effect on the treatment of climacteric syndrome, which not only could improve various kinds of clinical symptoms of the climacteric syndrome notably, but also hasn't obvious poisonous side effect.(2) Catgut embedding in points could improve clinical symptom obviously, benefit mind and body health, and enhance quality of life (QOL) of the postmenopausal women.(3) Catgut embedding in points could regulate the hypothalamic-pituitary- ovarian axis, and could improve the endocrine environment by raising serum E2, T level and reducing the serum FSH, LH level of the postmenopausal woman.(4) Catgut embedding in points could regulate bone metabolism. It could lower the bone transfer ratio by decreasing the level of BGP, CT and PTH and reclaim the negative balance of bone metabolism consequently so that it has positive meanings in preventing and curing the osteoporosis (OP) of postmenopausal women.(5) The curative effect of catgut embedding in points on women's climacteric syndrome was equal to the control group, but the safety of catgut embedding in points is better and the cases occurrence rate of untoward reactions is lower than that of the control group.3 Experimental researchPurpose: To probe the effect mechanism on women's climacteric syndrome treated with catgut embedding in points from the angle of animal experiment.Methods: The female SD rats with ovaries removed, were adopted as the animal model of menopausal pathology, and were divided randomly into ovariectomized model (OVX model) group (A), catgut embedding in points group(B),control group(C).At thesame time, built sham model group (D). Group B was treated with catgut embedding in points, once every 5 days, four times in all. Acupoints chosen in group B were as follows: Guanyuan(CV4), bilateral Sanyinjiao(SP6) and bilateral Shenshu(BL23). Group C was infused with Nilestriol 5ml/kg (lmg/kg ) once every 5 days, four times in all. Group A and D were infused with water 5ml/kg once every 5 days, four times in all. After being treated 4 times in succession, all of the experimental animals were put to death on the 5th day after the last treatment, and collected serums and samples, measured and observed the following indexes:(1) The content of E2, T, GnRH, FSH, LH in the serum.(2) The viscera index of brain, pituitary, uterus, adrenal gland and their organs' morphologic change.(3) The distribution and amount of estrogen receptor (ER) in the brain and uterus.(4) Dynamic observation on the change of body weight of every group during experiment (the first experimental day, the day before operation, the first, second, third, and fourth treatment day, and the thirtieth day after operation)Results:(1) Compared to group D, the body weight of group A tended to increase apparently;The body weight of group C decreased rapidly after the first treatment (PO.05), The body weight of B group decreased after the third treatment, the range of body weight of group B was no difference from that of group D in the end of therapeutic course(P>0.05);Compared to group D, that of group C changed significantly (PO.05).(2) The levels of serum GnRH, FSH and LH of group A were higher than those of group D (PO.05), while serum E2, T were lower than those of group D (PO.05), the change range of E2 was more significant than that of T. After treatment, the levels of E2 and T of group B were improved and the levels of serum FSH, LH and GnRH of groups B were reduced, the change of E2, T, LH and GnRH between group B and group A were no significant (P>0.05);There was no significant difference between group D and group B in the level of serum E2> FSH> LH (P>0.05),while significant difference between them the level of T and GnRH (PO.05);There was not significant difference between group B and group C in the change of E2, T, FSH, LH and GnRH (P>0.05).(3) After ovariectomized, the cortex nerve cells of the rats manifested ageing. Compared to group D, the nerve cells decreased significantly;After treatment the amount of nerve cells of group B increased significantly, and was no significant difference compared to group D (P>0.05), that of group C increased obviously but still less than that of group D.(4) Compared to group D, pituitary weight coefficient of group A decreased significantly (P<0.05), in addiction, the amount of the anterior lobe cell of pituitary decreased with the appearance of fluffy stained cells and reduced blood supply;After treatment pituitary weight coefficient of group B and C tended to increase with the decreasing in the amount of ovariectomized cells and increasing in blood supply while still different from those of group D.(5) After ovariectomized, the uterus manifested as thin wall, obvious atrophy, little and few glands with poor blood supply;After treatment the atrophy of uterus as a whole improved significantly compared to that of group A ( PO.Q5 ), especially endometrium hyperplasia, large glands and hyperactivity of glandular epithelium in group C, while there was no atrophy and hyperplasia phenomenon in group D.(6) The obvious atrophy of adrenal cortex happened in group A and group C, the form of adrenal grand was similar to that of group D;As for weight coefficient of adrenal gland, group B was the highest and group A the lowest, while there were no significant difference between the four groups (PX).O5 ) .(7) The expression amount of estrogen receptors(ER) in endometrium and its gland were most intensive than those of other tissue of the uterus, and there were some ER expressing in the uterus muscle cell and its stroma. In the vascular endothelial cell(EC) of brain cortex, the amount of ER expression were very intensive.Compared to group D, the amount of ER expression in uterus and brain cortex of group A decreased significantly (P<0.001);After treatment, the amount of ER expression in uterus and brain in both group B and group C increased significantly(P<0.001), and there was no significant difference among group B, C, and D in brain cortex (PX).O5 ) ,while in uterus that of group C increased more obviously than that of group B(P<0.01), and was no significant difference compared to group D(P>0.05).Conclusion:(1) Catgut embedding in points could effectively inhibit the increasing in the body weight of ovariectomized rats, and its integral regulation advantage was more distinct than that of estrogen replacement therapy(ERT).(2) Catgut embedding in points could regulate the hypothalamic-pituitary- gonad axis, and increase serum E2 and T, and reduce serum GnRH, FSH and LH of the ovariectomized rats.(3) Catgut embedding in points could improve the aging situation of the brain cortex of ovariectomized rats, and was better than that of ERT.(4) After ovariectomized, the uterus, pituitary and adrenal gland were manifested asageing;Catgut embedding in points could increase the weight coefficient of uterus, pituitary and adrenal gland, and improve the aging situation of the viscera mentioned above. Its stimulus to endometrium was less compared to that of ERT.(5) Catgut embedding in points could increase the amount of ER expression in vascular endothelial cell of both uterus and brain cortex, which could offer the valuable research clue for menopausal aging disease and senile cerebrovascular disease.
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