| ObjectiveBy investigating the correlation between TCM constitutions of Hong Kong women with primary dysmenorrhea, the occurrence rate, distribution pattern of associated TCM constitution, symptoms and related factors are studied. The result is combined with the various aspects of Hong Kong such as climate and environment, habits, social and cultural background.According to the characteristics of Hong Kong women, predisposed types of TCM constitution of female are correlated to primary dysmenorrhea. The overall incidence of various factors of Hong Kong individuality and locality differences can be explored. By conducting this study, we can guide the development of physical conditions by early intervention, prevention and regular health cares, providing enhancement to Hong Kong women’s health. Methods224women with primary dysmenorrheal according to the Chinese and western medicine inclusion criteria were recruited from three Evergreen Chinese Medicine clinics located in Tsuen Wan, Tuen Mun and Yuen Long district respectively in Hong Kong. The study was conducted from1May2013to31December2013.Women with primary dysmenorrhea were assigned to the experimental group while women without dysmenorrhea were assigned to the control group. The epidemiological study was conducted in the form of questionnaires.Recruited females were asked to fill out the survey questionnaire with a pen and fill in the corresponding position in the table. The questionnaire was in a closed questionnaire-based and hybrid selection form. Efforts were made to acknowledge the environmental factors and the way the questionnaire were filled, so as to obtain more comprehensive information and data. The questionnaires were collected on the spot to keep the data confidential.The survey consists of four parts:the standardized Constitution Chinese Medicine Questionnaires (CCMQ), dysmenorrheal symptoms and quantitative scoring criteria table, general survey of menstruation and primary dysmenorrhea related factors.Four questionnaires were used to investigate background information (the Hong Kong prevalence of recurrent primary dysmenorrhea and TCM constitution distribution), the primary dysmenorrhea,(general conditions, related factors and sources that aggravate or induce the disease), treatment (relief methods, treatment situation), and the correlation between TCM constitution and primary dysmenorrhea.TCM constitution was identified based on The standardized Constitution Chinese Medicine Questionnaires (CCMQ) developed by Professor Wang Qi. It is a standard appendix of Standardized TCM constitution classification and determination to determine the TCM Constitutions. This standard is the first guidance documents used on research and application of TCM constitution, promulgated by the Association of Chinese Medicine. CCMQ consists of9TCM constitution tables including Qi deficiency constitution, yin deficiency constitution, blood stasis constitution, qi stagnation constitution, Damp-heat constitution, special diathesis constitution, yang deficiency constitution, phlegm-dampness constitution, gentleness constitution. There was a total of61entries. This standard was based on an epidemiological investigation of21,948cases. The standard has been used as a universal guide or reference. This can be applicable to medicine, TCM research clinicians, researchers and relevant management personnel. This can also be used as a clinical practice to determine specifications and quality assessment important reference.The dysmenorrheal symptoms and quantitative scoring criteria table in Guiding Principles of Chinese Medicine Clinical Research New Drugs (1993edition) issued by the Ministry of Health by the People’s Republic of China was referenced. The symptoms of primary dysmenorrhea were quantified based on standard symptom scores in women with primary dysmenorrheal. The degree of primary dysmenorrhea was divided into3types:mild, moderate and severe.A questionnaire on general menstruation and general information of primary dysmenorrhea was prepared. Details include age, age at menarche, primary dysmenorrhea start age, menstrual cycle, menstrual duration, menstrual blood volume, texture, blood clots, body mass, family history of primary dysmenorrhea, treatment of primary dysmenorrhea.A questionnaire on primary dysmenorrhea related factors was prepared. It includes relevant factors such as sleep condition, stress condition, emotion factors, pregnancy factors, diet, exercise habits, bowel habits.With the above collected data, database was established by using Excel spreadsheet software. The raw data were pretreated and quantified before inputting the values. The SPSS version19.0statistical software was used for analysis. The data were verified with the xz test to obtain the test statistic. It derived the corresponding P value and a P value less than0.05is considered statistically significant while a P value less than0.01means a highly statistically significant test.ResultsHong Kong is densely populated with fast-paced life, keen competition and long working hours. Therefore, Hong Kong females have been faced with heavy pressures in recent years. The number of females entering the labor market has been on the rise. The female employment rate in2012increased by more than ten percent of that a decade ago. It has become increasingly common for married women to both work and take care of their family. Young women are under heavy academic pressure. Sorae start work earlier than their peers and thus have to adapt to working. Due to the consistently overheated property market in Hong Kong, the cost of living has been increasing. This casts a heavy burden on the citizens since most of the family income is mainly spent on housing, and in some cases the children’s education. All these pressures can be time consuming, leaving Hong Kong women sleep-deprived. A survey showed Hong Kong females do not have enough spare time, and so it is not easy for them to allocate more time on exercising. Under the current culture that holds slim bodies as aesthetically pleasant, Hong Kong women often employ unhealthy methods to lose weight. Sometimes such practices lead to various eating disorders such as anorexia. Individuality and locality are present among Hong Kong women due to a wide array of factors.According to the World Health Organization (WHO,1948),"Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".WHO once mentioned in the report Meet the challenges of21century that "In the21st century, medicine practice are developed from the "disease medicine" toward"health medicine"; from curative treatment direction toward preventive treatment direction; from confrontation to pathogens treatment toward the overall therapeutic development; from general treatment toward individualized therapy....."The idea of individualized treatment gradually seeps into clinical medicine. Such treatment method is people-oriented and will be the future development of medicine. The people-oriented individualized medicine practice is consistent with the disease prevention notion of Traditional Chinese Medicine (TCM). Through prevention and health protection, people can change the unhealthy lifestyles and better their health conditions.Dysmenorrhea is a common gynecological disease. It happens before menstruation or during menstrual period with main symptoms including abdominal pain that may radiate to the lumbosacral region. Dysmenorrhea is also associated with other systemic symptoms such as nausea, vomiting, chills, headache, dizziness,pale face, heavy sweating and serious syncope. These symptoms can seriously nterfere with the lives and work. The disease is divided into primary and secondary dysmenorrhea. The distinction is that the primary dysmenorrhea refers to pain occurring in the absence of pelvic pathology, unlike secondary dysmenorrhea that can be traced back to a source of identifiable organic diseases. Primary dysmenorrhea usually occurs in young women,1-2years after menarche. According to a national survey, the occurrence rate of dysmenorrhea was33.1%, of which36.06%was primary dysmenorrhea. A local survey showed that61.2%of Hong Kong women suffering from primary dysmenorrhea. However most people do not seek treatment. Instead, they prefer dealing with the discomfort using primitive measures, such as taking over-the-counter painkillers, bed resting, and warming the lower abdomen in the hope of pain relief. Only rare individuals are willing to have a medical consultation for the condition. This reflects a general lack of awareness of the primary dysmenorrheal among the local female population.Taking pain medications can only provide for short-term pain relieving effect, but a cure can never be reached. Also, prolonged intake of painkillers can induce a list of side-effects such as developing drug resilience or becoming over-reliant. TCM takes on an opposite direction, emphasizing preventive measure so that diseases will not occur in the first place. TCM treatment can identify the constitution of Hong Kong women and adjust the treatment for each patient. The individualized preventive measure can be applied before the menstrual period so as to prevent primary dysmenorrhea. This treatment method is effective in relieving, if not eliminating, primary dysmenorrhea. Early and appropriate intervention does not just treat the discomfort; it can reduce the relapse after stopping treatment. These are the advantages of TCM.TCM constitution is formed according to congenital and acquired factors. The qualities formed can differ depending on internal and external factors such as environment, mental states, nutrition and diseases.The physical characteristics of individuals can be altered and improved. By taking early intervention and appropriate preventive measures for different TCM constitution, individuals can improve their constitution to prevent the onset of diseases. Regional differences in the formation of different environmental factors such as customs, cultural differences, climate, geology, water and diet habits have a significant impact on the TCM constitution of people. Living in different geographical environment can alter its TCM constitution. This results in non-uniform distribution of TCM constitution.With known types of TCM constitution of Hong Kong women with primary dysmenorrhea, it is possible to issue suitable preventive measure that may include changes in daily diet, emotional recuperation, exercises and drugs. This can eliminate or improve dysmenorrhea symptoms and correct the initial constitution. By altering daily behavior, the physical and psychological pressures on Hong Kong be lifted, preventing future occurrence of primary dysmenorrhea.This study was conducted by studying the Hong Kong women with primary dysmenorrhea. It aimed to establish TCM constitution relationship, grasping the regional physical differences formed in Hong Kong female demography. The onset of disease can be prevented by identifying and reducing the risk factors so as to improve the pathological state of affected individuals and correct the biased physical state. This study is conducted according to "people oriented" and "environmental oriented" beliefs from TCM classic Yellow Emperor’s Inner Canon. Considering various aspects of Hong Kong’s geographical and climatic environment, social and cultural background, characteristics of Hong Kong women are determined. The differences in physical state for Hong Kong women and primary dysmenorrhea related factors can be identified.In this study,224questionnaires were collected, of which157cases were identified with primary dysmenorrhea (70.1%), meaning67cases without dysmenorrhea (29.9%). Among the224women in Hong Kong, the minimum age was16while the maximum age is40. The average age of primary dysmenorrhea group was27.68with an approximate deviance of±6.26years. The mean age in the group without dysmenorrhea was29.84±6.171years. With increasing age, a corresponding reduction in the prevalence of dysmenorrhea was found. Most of the recruited women in the survey were working and single.1. The TCM constitution types distribution of the primary dysmenorrhea group sorted in descending order are:Qi deficiency (61.8%); yin deficiency (52.2%); blood stasis (47.8%);qi stagnation (45.9%); yang deficiency (42.0%); phlegm-dampness (38.9%);Damp-heat (35.0%); special diathesis (22.9%); gentleness (7.6%). The TCM distribution types of non-dysmenorrhea group sorted in descending order are:Qi deficiency (44.8%); gentleness (34.3%); yang deficiency (31.3%); yin deficiency (29.9%); blood stasis (29.9%); phlegm-dampness (26.9%);damp-heat (26.9%); qi stagnation (26.9%); special diathesis (9.0%)2. Generally, Hong Kong women with primary dysmenorrhea treated their menstrual cramp mainly by placing a heating pad on abdomen (50.9%) followed by over-the-counter, self-prescribed painkillers (37.7%). Only a very small proportion would seek Chinese Medicine treatment (3.5%) or Western medicine treatment (1.8%).3. The biased constitution in primary dysmenorrheal group (346.5%) is higher than that in the group without dysmenorrhea (225.6%). Among the two groups, there are high statistical significance (P<0.01) in the qualitative distribution differences in Gentleness constitution and yin deficiency constitution. There are statistical significance (P<0.05) in the qualitative distribution differences in qi deficiency constitution, blood stasis constitution, qi stagnation constitution and special diathesis constitution. There are no statistical significance (P>0.05) in the qualitative distribution differences in yang deficiency constitution, phlegm-dampness constitution and damp-heat constitution.4. In this survey,157cases were identified with primary dysmenorrhea. They include severe dysmenorrhea group (10.2%), moderate dysmenorrhea group (56.7%) and mild dysmenorrhea group (33.1%).There are statistical significance (P<0.05) in the qualitative differences of dysmenorrheal degree in blood stasis constitution. In severe dysmenorrhea group, no Gentleness constitution could be observed.5. In the dysmenorrhea group,23.6%cases belonged to single constitution and76.4%belonged to complex constitution. In non-dysmenorrhea group44.8%belonged to single constitution and55.2%belonged to complex constitution. There are no statistical significance (P>0.05) when comparing constitutions between the two groups.6. In menstruation condition, there are statistical significance (P<0.05) in the qualitative differences of menstruation with blood clot.7. In the relevant genetic factors, there is highly statistical significance (P<0.01) in the qualitative differences of2groups in family history.8. In the relevant pregnancy factors, there is highly statistical significance (P<0.01) in the qualitative differences of natural childbirth. Thereis statistical significance (P<0.05) in the qualitative differences of never pregnancy.9. In the relevant emotional factors, there is is highly statistical significance (P<0.01) in the qualitative differences of emotional stability.10. In the relevant dietary factors, there is statistical significance (P <0.05) in the qualitative differences of coffee drinking habits.ConclusionHong Kong females have been faced with heavy pressures in recent years thanks to the fast-paced life, keen competition and long working hours in Hong Kong. The number of females entering the labor market has been on the rise. The female employment rate in2012increased by more than ten percent of that a decade ago. It has become increasingly common for married women to both work and take care of their family. Young women are under heavy academic pressure. Some start work earlier than their peers and thus have to adapt to working. Due to the consistently overheated property market in Hong Kong, the cost of living has been increasing. This casts a heavy burden on the citizens since most of the family income is mainly spent on housing, and in some cases the children’s education.All these pressures can be time consuming, leaving Hong Kong women sleep-deprived. A survey showed Hong Kong females do not have enough spare time, and so it is not easy for them to allocate more time on exercising. Under the current culture that holds slim bodies as aesthetically pleasant, Hong Kong women often employ unhealthy methods to lose weight. Sometimes such practices lead to various eating disorders such as anorexia. Individuality and locality are present among Hong Kong women due to a wide array of factors.1. The survey showed Hong Kong has a high prevalence of primary dysmenorrhea. The majority of primary dysmenorrheal group had a moderate degree of menstrual pain. Evidently, most of the Hong Kong women handle their menstrual cramps and the discomfort on their own. The most common self-help administered are heating pad on abdomen and painkillers. Only a small proportion of them are willing to seek medical advice. This reflected that Hong Kong women lack awareness of dysmenorrheal. With the increasing age, a corresponding reduction in the prevalence of dysmenorrheal was observed. That is, the greater the age, the less prevalent dysmenorrhea is.2. The former three predilection of primary dysmenorrheal group were Qi deficiency constitution, yin deficiency constitution and blood stasis constitution. The former three predilection of non-dysmenorrheal group were Qi deficiency constitution gentleness constitution and yang deficiency constitution. The most common constitution of Hong Kong women is the Qi deficiency constitution. The most common constitution of Hong Kong women with primary dysmenorrhea is also the Qi deficiency constitution. It shows that various factors including Hong Kong climate, lifestyle, diet preferences, social and cultural background established a local constitution of Hong Kong females. The second and third primary dysmenorrhea predilection constitution were yin deficiency constitution and blood stasis constitution. It shows the common attributes of Hong Kong females are yin-based, blood-oriented and blood-lacking.3. The majority of primary dysmenorrheal group are biased constitutions; only a small proportion of them are gentleness constitution. The majority of the primary dysmenorrhea group have multiple overlapping compositions. The women with complex composition are more likely to develop primary dysmenorrhea.4. Gentleness constitution is less likely to suffer from primary dysmenorrhea. The degree of primary dysmenorrhea of gentleness constitution was moderate and no case of severe dysmenorrhea was found. Biased constitution was prone to primary dysmenorrhea. The average degree of primary dysmenorrhea of biased constitution is moderate.5. Women dysmenorrhea factors are closely related to Hong Kong and family history of primary dysmenorrhea and pregnancy. In the family history of dysmenorrhea, if the sister or mother-had dysmenorrhea, the risk of dysmenorrhea increases. Pregnant women have lower risk of primary dysmenorrhea while those had higher the number of abortions have elevated risk of primary dysmenorrhea.6. In menstruation condition, menstruation with blood clot is the related factor that can induce or worsen primary dysmenorrhea. The more the number of menstrual blood clots, the higher the risk of primary dysmenorrhea. This result reflects the Chinese medicine theory "Blood stasis in Chong and Ren Meridians causes stagnation of blood flow which leads to pain sensation."7. In the relevant genetic factors, family history is the related factor that can induce or worsen primary dysmenorrhea. The family members having primary dysmenorrheal would increase the risk of primary dysmenorrheal.8. In the relevant pregnancy factors, natural childbirth and never pregnancy are the related factors that can induce or worsen primary dysmenorrhea. In the case of natural childbirth, women would have the lower chance of occurence of primary dysmenorrhea. In the case of never pregnancy, women would have higher chance of occurence of primary dysmenorrheal.9. In the relevant emotional factors, those with higher pressure are more likely to have primary dysmenorrheal, while those with stable emotion are less likely to have primary dysmenorrheal.10. In the relevant dietary factors, drinking coffee habit is the related factor that can induce or worsen primary dysmenorrhea. |
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