| ObjectiveThrough questionnaires of women with infertility in Thailand and Guangdong China to find out the distribution of TCM constitution and TCM syndrome types among infertile women in the two regions.Collecting risk factors such as living habits,diet,personality etc.to study their relationship with TCM constitution in infertility women of the two places.Exploring the distribution trend of different influencing factors and TCM constitution on infertile women,in order to promote the new ideas of prevention and treatment for treating infertile women to reduce the patients ’ s suffering and promote family harmony.In addition,the infertility cases of Prof.Songping Luo,the 3rd generation of Ling-nan Gynecological s school of thought,were collected and analyzed for their classification and prescription characteristics.The thinking way of Ling-nan Gynecological ’ s school of thought remedy was discussed in order to achieve prevention of infertility and improve the treatment efficiency and promoting the use of Traditional Chinese Medicine to treat infertility in Thailand.MethodsCollecting patient’s data from March until December 2018 in Thailand at:①Infertility Clinic Gynecology Department Maharaja Hospital Chiang Mai province;②Hua-qiao Traditional Chinese Medicine Hospital Bangkok;③Traditional Chinese Medicine Department Pattalong Hospital Pattalong province;④Traditional Chinese Medicine Clinics in Northeastern of Thailand;⑤De-ming Traditional Chinese Medicine Clinic Chantaburi Province in the east of Thailand.In Guangdong China:①Gynecological Clinic of the First Affiliated Hospital of Guangzhou University of Chinese Medicine Guangzhou City;②Gynecological Clinic of Shenzhen Maternal and Child Health Hospital Shenzhen City,only patients that has been diagnosed as infertility through diagnostic criteria were included in this study.The survey method is a face-to-face survey.The questionnaire was self-developed "Female Infertility Questionnaire" and "Traditional Chinese Medicine constitution Survey Form"officially issued by the Chinese Medical Association.After the questionnaires were completed,the TCM constitution and TCM syndrome analysis were carried out using the "Standard of TCM Constitution Classification criteria" and "TCM Gynecology",and all the data were entered into the Excel software to establish a database.Descriptive analysis and frequency analysis were performed using IBM SPSS 24.0 software.Pearson chi-square test or Fisher exact probability test was used to compare the influencing factors among the two regions.Multivariate logistic regression analysis was used to analyze the data.(the statistical significant value is P<0.05),the result is considered statistically significant.In addition,data mining is carried out for medical cases that have been treated more than three times or cases with successful pregnancy after treatment.Using Excel software to create and organize data,including basic information about patients,current medical history,TCM-Western medical diagnosis,TCM syndrome type,TCM prescription.Chinese medicine names in the prescription were gathered,organized and use in frequency and cluster analysis by IBM SPSS 24;the association rules analysis of the Chinese medicine was performed using IBM SPSS Modeler 18 software.ResultsThis research collected questionnaires from patients who were diagnosed as " female infertility”in Guangdong and Thailand from March 2018 to December 2018.A total of 885 questionnaires were collected,of which 821 questionnaires are valid,which could be divided into 512 questionnaires in Guangdong and 309 questionnaires in Thailand.The median age of infertility women in Guangdong is 33 years old,the oldest is 48 years old,and the youngest is 20 years old.The median age in Thailand is 34 years old.The oldest is 48 years old and the youngest is 21 years old.The difference in age of both groups are not significant(P>0.05).1.Comparison of the basic factors of infertility women in Guangdong and Thailand,found that age,food type,smoking habits,family type and relationship between husband and wife,cravings of people around patient are all the same(P>0.05),the two places are different(P<0.05)in(1)BMI:The number of normal BMI in the two places is the highest(63.5%in Guangdong and 61.5%in Thailand),but the too low BMI in Guangdong is(20.5%).More than Thailand too low BMI(14.9%),Thailand’ s too high BMI(23.6%)is more than China’ s Guangdong too high BMI(16%);(2)China’ s Guangdong infertile women’s residence is "city"(86.1%)more than Thailand "city"(64.4%);(3)The"undergraduate”education in the two places is the majority(45.1%in Guangdong and 52%in Thailand),while the second majority in Guangdong is"collage"(26%)and Thailand second majority is "master and above"(24.3%);(4)The majority occupation in China’ s Guangdong is "company staff"(34.6%),and majority occupation in Thailand is "civil servants(32.0%);(5)in terms of diet,Chinese infertility women in Guangdong prefer to eat "bland" tastes is the majority(30.9%),and Thailand majority is " Spicy"(30.4%);Guangdong Province often eats "warm soup" food(62.9%),and Thailand is "raw and cool food"(43.0%).China Guangdong often drinks "room temperature drink"(60.0%),while Thailand is more common with "cold drink"(53.4%).China’ s Guangdong prefers to eat "warm nature" diet(89.8%),while Thailand has the "cool nature”diet(66.0%);(6)Thai infertility women go to bed earlier,46.3%of Thai infertility women go to bed before 11:00 pm,while 57.6%of Chinese infertility women go to bed 11:00 pm-01:00 am;(7)Thailand infertility women has 20.7%with alcohol drinking habits which is higher than the infertility women in Guangdong(1.4%).The smoking habits of spouses in Guangdong(34.2%)is higher than those in Thailand(16.5%);(8)the infertile women with less exercise in Thailand(82.2%)were higher than Guangdong(73.0%);(9)Term of Giving birth expectation is graded into "extremely"(53.9%in Guangdong,56.6%in Thailand),"very" higher in Guangdong(38.3%)than Thailand(25.6%),and "general" which on the contrary is higher in Thailand(17.8%)compare to Guangdong China(7.8%);(10)In terms of personality,infertilee women in China Guangdong’ s character are "impatient and irritable"(38.3%)which is the highest,Thailand is the highest in "calm and cheerful" personality(42.7%);(11)China’ s Guangdong infertility women with life stress(81.3)%)is significantly higher than Thailand(52.4%).Among stresses," family pressure" is highest(32.2%)in Guangdong China,while Thailand’ s "work stress" is more common(26.8%).2.The Menstrual]eucorrhea between infertile women in Guangdong and Thailand is different in both regions(both P(0.05);the occurrence of menstrual abnormalities in Guangdong is more common in late menstruation(42.70%);Thailand Menstrual abnormalities were more common in dysmenorrhea(52.9%);Abnormal leucorrhea in Thai infertility women(26.9%)were higher than China’ s Guangdong(14.3%);Thailand women who never have gynecological diseases examination were higher(37.5%)than Guangdong China(7.2)%);In the case of gynecological diseases and problems,Endometriosis is the highest in Guangdong,China and PCOS in Thailand.3.Regarding the primary and secondary infertility of women in Guangdong and Thailand,the two regions are different(both P<0.05);China’ s Guangdong is more common with secondary infertility(61.1%),but primary infertility(69.9%)is more common in Thailand.The average duration of infertility in Guangdong,China is 2.76±2.210 years,and the longest period of infertility is 15 years.The average duration of infertility in Thailand is 4.66+3.73 years,and the longest period of infertility is 20 years.Most cases of infertility in Guangdong is in 1 year(33.2%),and most case in Thailand is 5 years(40.1%);About frequency of sexual intercourse Guangdong Infertile women are commonly once a week(51.9%),Thailand is 2-3 times a week(42.1%);Contraceptive measures before infertility,no contraception in both places is the highest(55.1%in Guangdong,China and 58.3%in Thailand),but women with contraceptive methods are vary in their choice.Condoms in Guangdong are more common(39.1%),while in Thailand is mainly contraceptive pills(31.1%).Thai infertility women whom did not check the cause of infertility(39.8%)higher than China’ s Guangdong(9.6%);the highest cause of infertility of both places is ovarian dysfunction(Guangdong China is 56.3%,Thailand 39.5%),followed by fallopian tube factors(24.4%in Guangdong,China,23.9%in Thailand);China’ s Guangdong infertility women have been treated systematically higher(82.4%)than Thai infertility patients(50.5%);Among them,Artificial Reproductive Technology treatment(ART)is higher in Guangdong China(33.6%)than Thailand(28.8%).4.A comparison of TCM constitution distribution of infertile women in Guangdong China and Thailand shows that the TCM constitution distribution of the two regions are different(P<0.001),and the two regions are more biased constitution than yin-yang harmony constitution.China’s Guangdong infertility women have a single constitution of 33.6%,complex constitution of 66.4%;of which,89.3%belongs to biased constitution;frequency ranked from high to low:yang asthenia(43.9%)>blood stasis constitution(42%)>qi asthenia(40.4%)>phlegm-dampness constitution(31.6%)>qi stagnation constitution(20.7%)>yin asthenia constitution(17.4%)>damp-heat constitution(9.8%),no allergic constitution.35.3%of Thai infertility women have single constitution,64.7%complex constitution,of which,84.5%of biased constitution;frequency ranking from high and low,blood stasis constitution(57.9%)>Yin asthenia constitution(31.1%)>phlegm-dampness constitution(27.8%)>yang asthenia constitution(21%)>qi stagnation constitution(19.4%)>qi asthenia constitution(18.1%)>damp-heat constitution(16.2%)>allergic constitution(1%).5.A correlation analysis of the factors affecting the bias constitution of infertility women in Guangdong China and Thailand found that age,BMI,place of residence,life stress,personality and mental state,sleep quality,and exercise habits all have different degrees of correlation(P<0.05).According to relevant analysis shows that biased constitution in infertility women of 40 years old is 9.04 times higher than that of 20 years old(95%CI 1.56,52.38);excessive BMI are more biased constitution than normal BMI.2.24 times(95%CI 1.13,4.47);living in "cities" have a higher biased constitution thanliving in rural areas 1.63 times(95%CI 1.03,2.58);infertility women with life stress have higher biased constitution than non-life stress 2.02 times(95%CI 1.33,3.09);infertility women with impatience and irritability have higher biased constitution than those with calm and cheerfulness" 2.18 times(95%CI 1.35,3.52),"quiet introversion" personality have biased constitution is 2.27 times higher than "calmand cheerful" personality(95%CI 1.43,5.15),infertility women with "depression" personality have higher biased constitution than the "calm and cheerful personality 3.74 times(95%CI 1.55,9.00);infertility women with good sleep quality have lower biased constitution than "normal" sleep quality by 63%(95%CI 0.23,0.58).From AUROC,the model prediction rate after fitting is 73.9%,which indicates that the model can predict the biased constitution of infertility women by 73.9%accuracy.6.A relevant analysis of the factors affecting the bias constitution of infertility women in Guangdong,China,found that BMI,life stress,personality and mental state,sleep quality and exercise habits have different degrees of relevance to the bias constitution of infert i lity women in Guangdong China(P<0.05).According to the relevant analysis,the bias constitution of "too high" BMI in China’ s Guangdong infertility women is 5.61 times higher than that of normal BMI(95%CI 1.33,23.73);the infertility women with high stress in China have 2.61 times higher biased constitution than in those absence of life pressure(95%CI 1.42,4.78);in Guangdong,China,the personality of "impatient and irritable" infertility is 2.94 times higher than the "calm and cheerful" personality(95%CI 1.47,5.86)),the personality of "depression" is 3.30 times higher than the personality "calm and cheerful"(95%CI 1.21,8.98);in Guangdong,China,the quality of sleep infertility patients with "good sleep" is 70%lower than quality of sleep "normal"70%(95%CI 0.16,0.56).Infertility in Guangdong,China,with exercise habits is 44%(95%CI 0.31,0.99)lower than without exercise habit.In addition,from AUROC,the model prediction rate of the model after fitting is 74.5%,indicating that the model can predict biased constitution of women infertility in Guangdong,China by 74.5%accuracy.7.A correlation analysis of the factors affecting the bias constitution of women with infertility in Guangdong,China,found that age,personality and mental state and sleep quality have varying degrees of correlation.Biased constitution in Thai infertility women with "quiet introversion" personality is 5.03 times higher than that of "calm and cheerfulness" personality(95%CI 1.46,17.27);Biased constitution of Thai infertility women with "good”sleep quality is 50%lower than that of wnormal" sleep quality(95%CI 0.26,0.96).From AUROC,the model prediction rate of the model after fitting is 72.2%,indicating that the model can predict biased constitution in women with infertility in Thailand by 72.2%accuracy.8.About Professor Luo Song Ping’ s diagnosis and treatment of infertility patients,this research collects 201 cases of infertility patients,with a total 986 prescriptions,the frequency of syndromes from high to low is:①Kidney yin asthenia syndrome;②Kidney asthenia syndrome;③Kidney asthenia and blood stasis syndrome;④Liver stagnation and kidney asthenia syndrome;⑤Spleen and kidney asthenia syndrome;⑥phlegm dampness syndrome:⑦Deficiency heat syndrome;⑧Blood stasis syndrome;⑨liver stagnation syndrome;⑩Qi and yin asthenia syndrome,Among the 986 prescriptions,there are 152 kinds of Chinese medicine.Most of the top 40 with high frequency of occurrence in the prescriptions are commonly used in gynecology,such as Tusizi(Cuscuta chinensis Lam.),Xuduan(Dipsacus asperoides C.Y.Cheng et T.M.Ai.)and Sangjisheng(Taxillus chinensis(DC.)Danser)can be found in Shoutai Pills;Shudihuang(Rehmannia glutinosa Libosch.),Danggui(Angellica sinensis(Oliv)Diels.),Baishao(Paeonia lactiflora Pall.)and Chuanxiong(Ligusticum chuanxiong Hort.)are found in Siwu decoction;Dangshen(Codonopsis pilosula(Franch)Nannf.),Baizhu(Afractylodes macrocephala Koidz),Gancao(Glycyrrhiza uralensis Fisch.)and Fuling(Paria cocos(Schw.))are found in Sijunzi decoction;Chaihu(Bupleurum chinense DC.),Danggui(Angellica sinensis(Oliv)Diels.),Fuling(Paria(Schw.)),Baishao(Paeonia lactiflora Pall.),Baizhu(Afractylodes macrocephala Koidz)and Gancao(Glycyrrhiza uralensis Fisch.)are found in Xiaoyao San.In the medicine pairing pattern,the top 10 pairing with the highest degree of support and confidence were:Tusizi-Sangjisheng;Tusizi-Shanyao(Dioscorea opposite Thunb.);Tusizi-Xuduan;Xuduan-Sangjisheng;Xuduan-Shanyao;Shanyao-Sangjisheng;Nuzhenzi(Ligustrum lucidum Ait.)-Baishao;Nuzhenzi-Shanyao;Nuzhenzi-Xuduan;Nuzhcnzi-Tusizi;Tusizi-Shanyao-Sangjisheng;Tusizi-Shanyao-Xuduan;Xuduan-Sangjisheng-Shanyao;Nuzhenzhi-Tusizi-Baishao;Nuzhenzi-Tusizi-Sangjisheng and so on.9.Using cluster analysis of SPSS 24,clustering drugs with frequency of 50 or more times into 4 groups:①The Cl group includes:Xuduan,Sangjisheng,Shanyao,Tusizi,Fupenzi(Rubus chingii Hu),Nuzhenzi,Baishao,Goji berry(Lycium barbarum L.),Shihu(Dendrobium loddigesii Rolfe.),Huangjing(Polygonatum sibiricum Red.),Shanzhuyu(Cornus officinalis Sieb.et Zucc.),Digupi(Lycium chinense Mill.),Hanliancao(Eclipta prostrata L.),Suanzaoren(Ziziphus jujube Mill.var.spinosa(Bunge)Hu ex H.F.Chou),Lizhi Seed(Litchi chinensis Sonn.),Tangerine seed(Citrusreticulato Blanco),most of the drugs belong to the product of invigorating and strengthening the kidney.②The C2 group includes:Baizhu,Dangshen,Huangqi(Astragalus memeranaceus(Fisch.)Bge.var.monholicus(Bge.)Hsiao),Qianshi(Euryale ferox Salisb.),Jinyingzi(Rosa laevigata Michx.)and Gancao,the drugs appearing belong to strengthening the spleen and replenishing qi.③ The C3 group includes:Chuanxiong(Ligusticum chuanxiong Hort.),Yujin(Curcuma wenyujin Y.H.Chen et C.Ling),Danshen(Salvia miltiorrhiza Bge.),Niuxi(Achyranthes bidentate B1.),Jixueteng(Spatholobus suberect us Dunn),Chenpi(Citrus reticulate Blanco),Xiangfu(Cyperus rotundus L.),Banxia(Pinellia terata(Thunb.))and Cangzhu(Atractylodes lancea(Thunb))appearing the drugs can be divided to treat phlegm and blood stasis and activating blood and qi.④The C4 group includes:Chaihu(Bupleurum chinense DC.),Jasmin(Jasminum officinule L.),Hehuanhua(Albizia julibrissin Durazz.),Yuanzi(Polygala tenuifolia Willd.),Shicangpu(Acorus to tarinowi i Schott.),Banjitian(Morinda officinalis How.),Danggui(Angellica sinensis(Oliv)Diels.),Shudiihuang(Rehmannia glutinosa Libosch.)and Fuling(Paria cocos(Schw.).Most of the herbal’ s function are for regulating liver qi and nourishing liver and blood production.These emerging drugs belong to Professor Songping Luo’ s which commonly used for the treatment of infertility.However,in the clinical practice,Professor Songping Luo is experienced,orderly,flexible,and good at using South herbs.Conclusion1.From the comparison of the TCM constitution distribution of infertile women in Guangdong and Thailand,it can be concluded that the TCM constitution distribution of the two regions is very different.Specifically:the two regions have biased constitution more than yin-yang harmony constitution:the frequency of TCM constitution distribution of women with infertility in Guangdong from high to low is Yang asthenia constitution>Blood stasis constitution>Qi asthenia constitution>Phlegm-dampness constitution>Qi stagnation constitution>Yin asthenia constitution>Damp heat constitution,no Allergic constitution;In case of Thailand from high to low is Blood stasis constitution>Yin asthenia constitution>Phlegm and dampness constitution>Yang asthenia constitution>Qi stagnation constitution>Qi asthenia constitution>Damp heat constitution>Allergic constitution.2.Regarding the factors affecting the biased constitution of infertility women found that age,BMI,place of residence,stress,personality,mental state,quality of sleep,and exercise habits all had different degrees of influence on the biased constitution of infertility women in the two regions.The bias constitution of women with infertility in Guangdong has different degrees of correlation with BMI,stress,personality and mental state,sleep quality and exercise habits.The biased constitution of women with infertility in Thailand has varying degrees of correlation with age,personality,quality of sleep.The accuracy of the category prediction criteria after each modularity fit was higher than 70%.3.Comparison of Risk factors in Guangdong China and Thailand,shown that although distribution of age,weight,type of food eaten,quality of sleep,smoking habits,family type and relationship between husband and wife,fertility cravings of people around are the same(P>0.05);but distribution of BMI,blood type,place of residence,education level,occupation type,taste of food,type of food that is often eaten,type of drink that is often consumed,dietary nature,time to fall asleep,sleep time,drinking habits,husband’ s smoking habits,exercise habits,Their own fertility cravings,personality and mental state,stress and stress types,menstrual abnormality types,gynecological disease and gynecological problems,leucorrhea condition,infertility type,infertility time,contraceptive methods,frequency of sexual intercourse,gynecology and Infertility examination,causes of infertility,TCM constitution,TCM syndromes are all different(P<0.05).4.Professor Songping Luo,the third descendant of the Ling-nan gynecology school of thought,has distinctive thinking for the diagnosis and treatment of infertility patients:firstly distinguishing the disease and syndrome,and clarifying the cause of the disease;regulates menstruation and fertility,focusing on reconciling the balance of yin and yang,paying attention to tonifying the kidney,strengthen the spleen,regulates the liver to achieve,the purpose of Yin-Yang harmony.Professor Songping Luo has long term clinical experience.She is not only flexible in prescription,but also good in using Southern Chinese Herbals.She also aims at helping infertility women,based on Shoutai Pills,Erzhi Pill,Si junzi decoction,Siwu decoction,Xiaoyao san,etc.Adjusting prescription according to patient’s syndrome,will have very good clinical result.5.Regarding the diagnosis and treatment of women with infertility in Thailand,the study shows that detailed diagnosis and treatment should be carried out according to the "Theory of Three Cause" of Chinese medicine.Such as:pay attention to the local geographical environment characteristics;season and climate;patient’s TCM constitution,lifestyle and so on.Only treatment that concern the difference of TCM constitutions,seasons,geographical can get a good result. |
PDF Full Text Request