Clinical Literature Research Of Traditional Chinese Medicine For Luteal Phase Defect In The Past 20 Years

Research purposeThe clinical research literature on TCM dysfunction in the past 20 years was collected and systematically evaluated and meta-analyzed.Evaluation of clinical efficacy of traditional Chinese medicine in the treatment of luteal insufficiency,I hope to find out the shortcomings and advantages of traditional Chinese medicine in the treatment of luteal insufficiency,and provide reference for future clinical research.In addition,Under the guidance of TCM theory,the treatment of corpus luteum insufficiency is summarized and statistically analyzed.Trying to organize and analyze the rules for the treatment of luteal insufficiency,and thus better guide the clinical,in the hope of exploring new clinical treatment and Prescription medication ideas.MethodsTo develop a search strategy,to consult the domestic and international literature on the treatment of corpus luteum insufficiency in Chinese medicine,to develop exclusion and inclusion criteria,to use computer search literature,to search and analyze the clinical research literature of Chinese medicine for luteal insufficiency.1.meta analysis:Methodological evaluation for systematic evaluation is based on the“biased risk assessment tool" recommended by the Cochrane Collaboration Network for RCT literature quality evaluation;inclusion and exclusion criteria in RCT literature,efficacy criteria,randomization method,sample content,The comparison between group balance,blind method,treatment,statistical methods,follow-up,withdrawal and loss of follow-up were performed in SPSS 25.0 software for descriptive analysis.The literature was included in the meta-analysis,and the collected data were analyzed using the statistical software Revman 5.3.5 provided by the Cochrane Collaboration Network to evaluate the efficacy of TCM treatment of luteal insufficiency.2.Distribution of TCM syndromes and frequency and regularity of drug use:Statistical analysis is carried out regardless of high quality or low quality literature,and Excel software and SPSS 25.0 statistical software are used to establish a database for Frequency and Cluster analysis.Results1.Meta analysisThe analysis results of assessing the risk of bias in 57 studies included:16 studies(28.07%)were randomly selected,randomized,and coined,and rated as“low risk”,2 studies.(3.51%)were randomized according to the order of treatment,and were rated as "high risk";in the allocation of hidden items,none of the documents were mentioned,and the assessment was "unknown risk";3 studies(5.26%)mentioned blind method,but Without detailed description,the rest of the studies did not blindly implement the practitioners and included patients,nor did they implement a blind method for the surveyors,which was assessed as "high-risk" implementation and measurement bias;only one included(1.75%)Report missing or excluded,and the number of missing<20%,rated as "low risk",the rest of the study did not mention so that no judgment can be made;all the included studies did not have enough information to assess whether there are other potential risks,such as special Trial design,early termination of research,deceptive behavior,etc.,assessed as "unknown risk".To sum up,the 57 literatures in this study are all C-level literature,and the overall literature quality is low.A total of 5347 cases were enrolled in 57 studies,with homogeneity between the studies(P=0.84,I2=0%).The total effective rate of the experimental group compared with the control group for luteal insufficiency[OR=4.61,95%CI(3.86,5.51,P<0.00001)].Chinese medicine treatment of western medicine for the treatment of luteal insufficiency,a total of 2591 cases of 30 studies,the heterogeneity of each study was acceptable(P=0.62,I2=0%),the total effective rate[OR=4.37,95%CI(3.43,5.57,P<0.00001)].Western medicine combined with western medicine for the treatment of luteal insufficiency,25 cases with a total of 2510 cases,with homogeneity between each study(P=0.97,I2=0%),total effective rate[OR=4.43,95%CI(3.38,5.82,P<0.00001)].Acupuncture combined with traditional Chinese medicine treatment of western medicine for luteal insufficiency,220 cases of 2 studies,the heterogeneity of each study is acceptable(P=0.18,I2=44%),total effective rate[OR=4.35,95%CI(1.97,9.61,P=0.0003)].Chinese medicine treatment of western medicine for the treatment of luteal insufficiency infertility,7 studies in a total of 663 cases,with homogeneity between the studies(P=0.71,I2=0%),total effective rate[OR=2.13,95%CI(1.52,2.98,P<0.0001)].Chinese and Western medicine combined with western medicine for the treatment of luteal insufficiency infertility,14 cases with a total of 1383 cases,with homogeneity between each study(P=0.65,I2=0%),total effective rate[OR=3.12,95%CI(2.45,3.96,P<0.00001)].2.TCM syndrome distributionThe top 4 Chinese medicine syndromes with high frequency are kidney deficiency liver stagnation(44 frequency),kidney deficiency(22 frequency),kidney yang deficiency(16 frequency),kidney yin deficiency(8 frequency),luteal insufficiency The distribution of TCM syndromes is closely related to the kidney.It can be seen that the onset of luteal insufficiency is mainly caused by kidney deficiency,and has the main etiology and pathogenesis of liver depression.Therefore,the rule of law should be based on tonifying the kidney,and soothing the liver.3.Analysis of the frequency and regularity of basic medicationAmong the 261 articles in the literature,192 kinds of drugs were used to treat luteal insufficiency,the total frequency of use was 3638 flavors,and 138 drugs with frequency greater than or equal to 2 were used,a total of 3584 times,accounting for 3584 times.The frequency of drug use was 98.51%;there were 54 drugs with a frequency of less than 2,54 times,accounting for 1.49%of the total drug frequency.There are 37 flavors of drugs that appear more than 25 flavors(including 25 flavors).The order of occurrence in the literature from high to low is:SHUDIHUANG,TUSIZI,DANGGUI,GOUQIZI,SHANZHUYU,SHAOYAO,XIANLINGPI,XIANGFU,XU DUAN,DANGSHEN,NVZHENZI,BAIZHU,CHAIHU,FULING,MOHANLIAN,CHUANXIONG,DUZHONG,DANSHEN,HUANGQI,BAJITIAN,SANGJISHENG,CHISHAO,GANCAO,ROUSONGRONG,MUDANPI,E JIAO,ZISHIYING,FUPENZI,HESHOUWU,ZIHECHE,XIANMAO,ZELAN,ZHIGANCAO,YUJIN,YIM UCAO,WULINGZHI.Drug type analysis:The 192 traditional Chinese medicines for treating luteal insufficiency described in the literature studied belong to 19 drug types.Classification norms,refer to "Chinese Pharmacy" are solution medicine,heat-clearing medicine,diarrhea medicine,rheumatism medicine,chemical medicine,water-wetting drug,Wenli medicine,qi medicine,digestion medicine,hemostatic medicine,blood circulation medicine,Huatan Zhike antiasthmatic drugs,Anshen medicine,Pinggan Xifeng medicine,Kaiqiao medicine,tonic medicine,phlegm medicine,detoxification,insecticide,dampness and antipruritic drugs.Among the selected literatures,the top 7 drugs for treating luteal insufficiency were:the high frequency category:Tonic(22.63%):commonly used qi medicines include SHANYAO,DANGSHEN,BAIZHU,HUANGQI,GANCAO,RENSHEN,XIYANGSHEN,etc.Commonly used blood medicines include SHUDIHUANG,BAISHAO,DANGGUI,EJIAO,HESHOUWU,etc.Commonly used yang medicines include TUSIZI,XIANLINGPI,XUDUAN,DUZHONG,BAJITIAN,ROUSONGRONG,ZIHECHE,XIANMAO,LUJIAOSHUA NG,etc.,commonly used yin medicine are GOUQIZI,NVZHENZI,MOHANLIAN,GUIBAN,MAIDONG,SANGSHEN,HUANGJING.Heat-clearing drugs(11.58%):commonly used heat-clearing drugs include CHISHAO,MUDANPI,SHENGDIHUANG,HUANGQIN,SHANZHIZI,HUANGBAI,etc.Hemostatic drugs(11.58%):commonly used hemostatic drugs include WULINGZHI,AIYE,PUHUANG,SANQI,XIANHECAO,QIANCAOGEN,PAOJIANG,AIYETAN,ZHUMAGEN,etc.Activating blood and removing stasis drugs(11.03%):commonly used blood stasis drugs include CHUANXIONG,DANSHEN,ZELAN,YUJIN,YIMUCAO,HONGHUA,TAOREN,CHUANNIUXI,NIUXI,JIXUETENG,YANHUSUO,etc.Qi medicine(7.37%):commonly used qi medicines are XIANGFU,CHENPI,QINGPI,ZHIQIAO,MUXIANG,WUYAO,JUYE,CHUANLIANZI and so on.Solution medicine(5.79%):commonly used table drugs include CHAIHU,GUIZHI,SHENGMA,JINGJIE,BOHE,ZISUGENG,GEGEN,etc.Anshen medicine(5.26%):commonly used tranquil medicines include ZISHIYING,HEHUANPI,LONGGU,YUANZHI,SUANZAOREN,BOZIREN,etc.The cumulative ratio of all the top 7 drug categories was as high as 75.26%.Drug cluster analysis:According to the theory of medicinal properties(sexual taste,returning to the classics),using SPSS 25.0 software to establish a database of 48 drugs with more than 18 times of drug discovery frequency,a total of 5 clusters were obtained:C1LUYONG(LUJIAOPIAN,LUJIAOJIAO,LUJIAOSHUANG),ROUSONGYONG,SHANZHUYU,FUPENZ I,MOHANLIAN,XIANLINGPI,BAIJITIAN,XUDUAN,SHUDIHUANG,DUZHONG,TUSIZI,ZIHECHE,WUWEIZI.C2 SHANYAO,DANGSHEN,HUANGQI,GANCHAO(SHENGGANCAO,ZHIGANCAO),FULING.C3 BUGUZHI,CHENPI,ZELAN,BAIZHU,WULINGZHI,BAISHAO,XIANMAO,ROUGUI,ZISHIYING,HONGHUA,DANGGUI,CHUANXIONG.C4 SHENGDIHUANG,GUIBAN,CHAIHU,YUJIN,DANSHEN,CHISHAO,MUDANPI,YIMUCAO.C5 HESHOUWU,TAOREN,XIANGFU,SANGJISHENG,GOUQIZI,EJIAO,NVZHENZI.Conclusion1.TCM,combination of Chinese and Western medicine,acupuncture combined with traditional Chinese medicine for the treatment of luteal insufficiency are superior to western medicine.2.The pregnancy rate of traditional Chinese medicine and Chinese and Western medicine combined with luteal insufficiency infertility is better than western medicine.3.TCM is one of the effective ways to treat diabetes of luteal insufficiency.However,the methodological quality of randomized controlled trials is low and there is a high risk of bias.TCM syndrome distribution and medication patterns:1.The main TCM syndromes are kidney deficiency,liver deficiency,kidney deficiency,kidney yang deficiency and kidney yin deficiency.The distribution of TCM syndromes of luteal insufficiency is closely related to the kidney.The onset of luteal insufficiency is mainly caused by kidney deficiency,and has the main etiology and pathogenesis of liver depression.2.The rule of law should be based on tonifying the kidney,and soothing the liver.3.The treatment of luteal insufficiency is based on tonic medicine,heat-clearing medicine and hemostatic medicine,and also takes the blood circulation and phlegm medicine,qi medicine,solution medicine,and tranquil medicine.4.According to the theory of medicinal properties(sexual taste,returning to the classics),the five clusters were clustered to treat the corpus luteum insufficiency of each syndrome:liver and kidney deficiency syndrome,spleen and kidney qi deficiency syndrome,kidney deficiency,qi stagnation Sputum syndrome,liver qi stagnation,blood stasis has heat syndrome,kidney deficiency and blood stasis syndrome.