The Effect Of Traditional Chinese Medicine On Pregnancy In Patients With Adenomyosis And The Discussion On The Medication Rules Of Professor Zhao Ruihu

Objective:1 To systematically evaluate the clinical efficacy of TCM in the treatment of patients with adenomyosis with fertility needs based on Cochrane systematic review,and to provide evidence-based evidence for the influence of TCM on pregnancy related to adenomyosis.2 The effect of TCM on pregnancy in patients with adenomyosis was analyzed retrospectively.To explore the related factors of pregnancy in patients with adenomyopathy.3 Based on data mining technology,the medication rule of Professor Zhao Ruihua in the treatment of patients with adenomyosis with fertility needs was discussed.Methods:1 Meta-analysisSearch the Chinese and English databases and import the literature into Endnote to determine the eligible literature for inclusion according to the proposed inclusion and exclusion criteria.The "Bias risk Assessment tool" provided by《The Translation of Cochrane Handbook for Systematic Reviews of Interventions》was used to evaluate the quality of the literature,and the graph was drawn.The valid data of each study were extracted and imported into Revman 5.3 for statistical analysis.2 Efficacy observation and analysis of relationshipThe patient’s information was extracted from the previous medical records,and the pregnancy status of the patient was followed up by telephone.Patients were grouped according to whether they were pregnant or not,and relevant data were preprocessed.SPSS 26.0 was used to analyze the data and draw the research conclusions.The χ2 test was used to classify the data.The risk factors of pregnancy in patients with adenomyosis were obtained by Logistic analysis,and the difference was considered statistically significant when P<0.05.3 Data miningTongue,pulse and prescription information were collected and divided into four types according to TCM syndrome differentiation.According to the treatment cycle of traditional Chinese medicine,it can be divided into two periods:pre-ovulation and post-ovulation.The complex network was used to analyze the above data to study the medication rules of Professor Zhao Ruihua in the treatment of adenomyosis to assisting pregnancy and relieving fetus and to explore the core prescriptions and compatibility rules.Results:1 Meta-analysisA total of 11 literatures with 804 patients were included.The results of Meta-analysis showed:the pregnancy rate of the experimental group was higher than that of the control group(OR=3.61,95%CI[2.48,5.24],Z=6.74,P<0.00001);the rate of embryo implantation in experimental group was higher than that in control group(OR=2.01,95%CI[1.24,3.27],Z=2.83,P=0.005);the endometrial thickness of experimental group was greater than that of control group(MD=1.07,95%CI[0.24,1.90],Z=2.54,P=0.001);the total effective rate of experimental group was higher than that of control group(OR=5.79,95%CI[1.91,17.57],Z=3.10,P<0.002);the uterine volume of the experimental group was smaller than that of the control group(MD=-25.30,95%CI[-35.19,-15.40],Z=5.01,P<0.00001);the incidence of adverse reactions was similar between the experimental group and the control group(OR=0.68,95%CI[0.2,2.27],Z=0.63,P=0.53).2 Efficacy observation and analysis of relationshipA total of 129 patients with adenomyosis with pregnancy need were included,and the median duration of medication was 5(3,6)months.There were 60 pregnant patients with a total pregnancy rate of 46.51%(60/129),and the pregnancy rate of patients with infertility was 40.00%(40/100).χ2 analysis results show that age(χ2=19.778,P<0.001),disease course(χ2=6.129,P=0.013),chronic pelvic pain(χ2=4.403,P=0.036),menstrual volume(χ2=13.337,P=0.001),infertility(χ2=7.581,P=0.006),endometriosis(χ2=4.789,P=0.029),uterine volume(χ2=17.194,P<0.001)and FSH level(χ2=12.883,P<0.001)were statistically significant.Logistic regression analysis results show that age(OR=0.252,95%CI0.093～0.682,P=0.007),chronic pelvic pain(OR=0.205,95%CI 0.050～0.844,P=0.028),menstrual volume(OR=0.137,95%CI0.033～0.573,P=0.007),infertility(OR=0.292,95%CI0.091～0.932,P=0.038),endometriosis(OR=0.174,95%CI 0.060～0.509,P=0.001),uterine volume(OR=0.111,95%CI0.030～0.413,P=0.001),and FSH level(OR=0.247,95%CI 0.065～0.936,P=0.040)were significantly correlated with pregnancy in adenomyosis patients between the two groups.3 Data miningCore tongue and pulse:The core tongue and pulse in the syndrome of qi stagnation and blood stasis are tongue dark red,pale red tongue,thin white moss and wiry slippery pulse;the core tongue and pulse in the syndrome of qi deficiency and blood stasis are pale red tongue,dark red tongue,thin white moss,thick white moss and wiry thready pulse;the core tongue and pulse in the syndrome of cold coagulation blood stasis are pale and dark tongue,dark red tongue,thin white moss,thick white moss,tooth-marked tongue,pulse sinking and wiry,wiry thready pulse;the core tongue and pulse in the syndrome of phlegm-dampness stagnation are pale red tongue,thick white moss,tooth-marked tongue,pulse sinking and sliding.Core prescription analysis(pre-ovulation)is as follows.Qi stagnation and blood stasis syndrome:Bupleurum,white peony root,Cassia twig,membrane of chicken gizzard,Coix seed,Liquorice root,Tangshen,Indian Bread,Largehead Atractylodes Rhizome,villous amomum fruit,Panax notoginseng,Danshen Root,common fenugreek,ginger,etc.Qi deficiency and blood stasis syndrome:Tangshen,Indian Bread,Largehead Atractylodes Rhizome,Cassia twig,villous amomum fruit,cablin patchouli herb,Coix seed,membrane of chicken gizzard,Panax notoginseng,common fenugreek,white peony root,ginger,Chinese date,Liquorice root,Glycyrrhizae Radix et Rhizoma Praeparata Cum Melle,etc.Cold coagulation blood stasis syndrome:cyperus rotundus,Danshen Root,Cassia twig,membrane of chicken gizzard,Coix seed,Panax notoginseng,white peony root,Largehead Atractylodes Rhizome,Indian Bread,common fenugreek,turmeric,Tangshen,dried ginger,Liquorice root,etc.Phlegm-dampness stagnation syndrome:Chinese Angelica,white peony root,Cassia twig,Sichuan lovage rhizome,Indian Bread,Polyporus Umbellatus,Oriental Waterplantain Rhizome,Largehead Atractylodes Rhizome,Panax notoginseng,membrane of chicken gizzard,Coix seed,dried tangerine peel,ginger processed pinellia,dried ginger,common fenugreek,etc.Core prescription analysis(post-ovulation):The postovulation prescription is based on the preovulation,and the medicine of tonifying kidney is added.Pregnancy preservation core prescription:Tangshen,Largehead Atractylodes Rhizome,Indian Bread,villous amomum fruit,ginger,Chinese date,Dodder Seed,Lycii Fructus,himalayan teasel root,Lily Bulb,Glossy Privet Fruit,morinda root,medicated leaven,Glycyrrhizae Radix et Rhizoma Praeparata Cum Melle,Liquorice root,Largehead Atractylodes Rhizome,cablin patchouli herb,etc.Conclusions:The results of Meta-analysis:TCM has certain advantages in pregnancy rate,embryo implantation rate,improvement of endometrial thickness during the window period,total effective rate and reduction of uterine volume and does not increase the incidence of adverse reactions.This study confirms that there is evidence to support TCM treatment in promoting pregnancy in patients with adenomyopathy,but a large sample of high-quality randomized controlled clinical trials are needed to further confirm the role of TCM treatment in promoting pregnancy in patients with adenomyopathy.Chinese medicine treatment promotes pregnancy in patients with adenomyosis who have fertility needs.Age less than 35 years and FSH less than 10 mIU/mL are independent protective factors for pregnancy in patients with adenomyosis.Independent risk factors for non-pregnancy in patients with chronic pelvic pain,abnormal menstrual volume,infertility,endometriosis,and adenomyopathy with enlarged uterine volume.These results provide a basis for the prevention and treatment of pregnancy problems in patients with adenomy osis.Professor Zhao Ruihua treats patients with adenomyosis who have fertility needs in two periods before and after ovulation.Professor Zhao Ruihua pays attention to the application of drugs to promote blood circulation and remove blood stasis while promoting circulation of qi and blood,replenishing qi to invigorate the spleen,warming yang and activating blood,phlegm and dispelling stasis for assisting pregnancy before ovulation.Post-ovulation prescription adds tonifying kidney herbs based on pre-ovulation prescription and appropriate application of blood circulation and blood stasis drugs.Early pregnancy is mainly to tonify kidney for preventing miscarriage,while taking into account the spleen and stomach.