| ObjectivePolycystic ovary syndrome(PCOS),characterized by amenorrhea, anovulation and hyperandrogenism,is the most frequent androgen disorder of ovarian function,It affects 5-10%of women.Clinically,PCOS is a combination of three components:hyperandrogenic state,disorder of ovulation (anovulatory)and disorder of metabolism.Accumulating evidence suggests that PCOS patients have a higher risk to develop diabetes mellitus,hypertension and cardiovascular disease.Thus,we should pay much attention to the etiology, clinical associations and assessment of treatment on PCOS.Some investigators state that the development of follicle is related with the autonomic nervous system(ANS),but Traditional Chinese Medicine(TCM)believes that liver governing free coursing affects the conversion of yin and yang into each other in the period of ovulation.Moreover,the function of liver is related with autonomic nerve system in tradition Chinese medicine.In this study,we first investigated the relationship between ovulation and autonomic nervous system through heart rate variability(HRV)analysis in healthy women.Second,we studied the traditional Chinese medicine clinical pattern identification of PCOS and its relationship with heart rate viability.Finally,we treated PCOS patients with traditional Chinese medicine plus acupuncture in order to estimate the therapeutic effect of traditional Chinese medicine on PCOS.Using heart rate variability analysator to determine the related data can help us further realize the relationship between the disorder of ovulation and autonomic nervous system.Methods1.Study of the relationship between the ovulation and autonomic nervous systemThe HRV index(the SDANN and the ratio of LF/HF)of 35 healthy women was detected on the 9th,14th,and 19th day of menstrual cycle.These data were collected and analyzed.2.Study of the relationship between the clinical patterns and HRV and evaluation of the therapeutic effect of TCM on PCOS patientsAccording to the traditional Chinese medicine clinical pattern identification,30 amenorrhea or vibriosispatients from ST.Joseph Hospital, Kaohsiung,Taiwan,were classified into two patterns:liver depression transforming into fire pattern and non-liver depression transforming into fire pattern.Their age,weight(kg),height(m),waist(cm),hip(cm)and blood pressure(mm/Hg)were recorded and the WHR,BMI and Ferriman-Gallwey score were calculated.The SDANN and the ratio of LF/HF of these patients were detected and the level of serum prolectin,free testosterone,insulin-like growth factor-1(IGF-1),cholesterol and triglyceride were examined.According to the traditional Chinese medicine clinical pattern,addition of medicine was given to the basic formula and these patients take this traditional Chinese medicine after meals three times a day.The basic formula of traditional Chinese medicine contains Rehmanniae Radix et Rhizoma,Corni Fructus,Cuscutae Semen,Cervi Cornu,Cyathulae Radix,Biotae Semen,Lycopi Herba,Cirri Reticulatae Pericarpium,Proia,Pinelliae Rhizoma and Salviae Miltiorrhizae Radix.On the 10th day of menstrual cycle,we started to treat with electric acupuncture once a day for 7 days on these cases.This treatment contains 3 courses and one course persists for 30 days.In addition,as a control group, 5 patients without any medicine treatment were randomly selected.After treatment for 3 month,the SDANN,the ratio of LF/HF,the level of serum free testosterone,the level of serum IGF-1 were examined again.Results1.In the 35 health women,the SDANN is significantly increased and the ratio of LF/HF is significantly decreased on the period of ovulation(the 14th day of menstrual cycle).2.Before treatment with traditional Chinese medicine,the level of serum free testosterone of the PCOS patients is higher the normal range.However,the level of serum prolectin,cholesterol and triglyceride is in the normal range.3.According to the traditional Chinese medicine clinical pattern identification,30 cases were classified into two patterns:the liver depression transforming into fire pattern and the non-liver depression transforming into fire pattern.There are 22 cases of liver depression transforming into fire pattern(73.3%)and 8 cases of non-liver depression transforming into fire pattern(26.7%).HRV analytic results showed that the SDANN of the liver depression transforming into fire pattern patients is significantly lower than the non-liver depression transforming into fire pattern patients(P＜0.05).However,the age and the ratio of LF/HF of the liver depression transforming into fire pattern patients is not significantly different from the non-liver depression transforming into fire pattern patients(P＞0.05).4.The level of serum free testosterone of the liver depression transforming into fire pattern patients are significantly higher than the non-liver depression transforming into fire pattern patients(P＜0.05).However,the level of IGF-1 of the liver depression transforming into fire pattern patients are not significantly different from the non-liver depression transforming into fire pattern patients(P＞0.05). 5.After treatment with traditional Chinese medicine combination with acupuncture,the F-G score of PCOS patients significantly decreased (P＜0.01),but the BMI and WHR did not significantly change(P＞0.05).6.After treatment with traditional Chinese medicine combination with acupuncture for 3 month,the SDANN of the PCOS patients is significantly increased(P＜0.05)and the ratio of LF/HF is significantly depressed (P＜0.01).However,SDANN and the ratio of LF/HF of the control group without medical treatment did not significantly change.7.After treatment with traditional Chinese medicine combination with acupuncture for 3 month,the level of serum free testosterone and IGF-1 of the PCOS patients are significantly decreased(P＜0.01,and P＜0.05).The level of serum free testosterone and IGF-1 of the control group without medical treatment did not significantly change.8.After treatment with traditional Chinese medicine combination with acupuncture for 3 month,the SDANN of the liver depression transforming into fire pattern patients is significantly increased(P＜0.05)and the ratio of LF/HF is significantly depressed(P＜0.01).However,the SDANN and the ratio of LF/HF of the non-liver depression transforming into fire pattern patients did not change significantly.In addition,after treatment, SDANN and the ratio of LF/HF of the liver depression transforming into fire pattern patients and the non-liver depression transforming into fire pattern patients are not significantly different.9.After treatment with traditional Chinese medicine combination with acupuncture for 3 month,the level of serum free testosterone of the liver depression transforming into fire pattern patients are significantly decreased(P＜0.01)but the level of IGF-1 did not significantly change. The level of serum free testosterone and IGF-1 of the non-liver depression transforming into fire pattern patients are significantly changed(P＜0.01, and P＜0.05).Conclusions 1.The SDANN and the ratio of LF/HF are significantly changed in the ovulation period in healthy women.It suggested that autonomic nerve system may play an important role in menstrual cycle,especially in the induction of ovulation.2.The liver depression transforming into fire pattern is a major pattern of PCOS.The SDANN of the liver depression transforming into fire pattern patients is significantly lower than the non-liver depression transforming into fire pattern patients.It suggested that there is a more remarkable obstruction in the autonomic nerve system in the liver depression transforming into fire pattern patients.3.After treatment with traditional Chinese medicine combination with acupuncture,the SDANN and the ratio of LF/HF is significantly changed. It suggested that the treatment of traditional Chinese medicine combination with acupuncture can markedly improve the disorder of autonomic nerve system.4.After treatment with traditional Chinese medicine combination with acupuncture,the level of serum free testosterone and IGF-1 are markedly depressed in PCOS patients.These results showed that the treatment of traditional Chinese medicine combination with acupuncture can decrease the concentration of serum free testosterone and IGF-1,in addition to improve the disorder of autonomic nerve system.These changes may induce ovulation in PCOS patients.5.The treatment of traditional Chinese medicine combination with acupuncture is more effective on the liver depression transforming into fire pattern patients than the non-liver depression transforming into fire pattern patients.It proves that there is a close relationship between the traditional Chinese medicine pathology of liver governing free coursing and the disorder of autonomic nerve system.The primary goal of the treatment of traditional Chinese medicine for the liver depression transforming into fire pattern patients should is to improve the disorder of autonomic nerve system.6.In this study,we found that autonomic nerve system and endocrine network play important roles in menstrual cycle,especially in induction of ovulation.The disorder of autonomic nerve system and endocrine network may be the major reasons for etiology of PCOS.It needs further investigation to realize the relationship between the autonomic nerve system and the endocrine network.7.The traditional Chinese medicine suggested that there is a close relationship between the liver governing free coursing and ovulation. Although the reason of anovulation in PCOS is related with the disorder of liver,spleen and kidney,we prove that the etiology of PCOS is closely related with liver governing free coursing and the liver depression transforming into fire in this study.
|
PDF Full Text Request