The Literature Review And Clinical Study Of TCM Treatment On Women’s Menopausal Syndrome By Replenishing Kidney And Heart

Objective:In this study, we aimed at reviewing TCM literature of the recent20years on menopause’s etiology and treatment, as well as to investigate the treatment principle on replenishing kidney and heart. With the help of Kupperman Index and Menopause-Specific Quality of Life (MENQOL) surveys, we also observed the effectiveness on symptoms’relief and quality of life improvement by the standard TCM Replenishing Kidney and Heart herbal formula on menopause women.Methods1. Literature Review1.1Data sources and searchesAn electronic search on the China National Knowledge Infrastructure (CNKI) in between1994-2013was completed. The search terms were:combination of menopause, TCM, lethargy, depression, hysteria, palpitations, insomnia, osteoporosis.1.2Inclusion and exclusion criteriaPapers which were related to TCM herbal treatment of menopause or menopausal related lethargy, depression, hysteria, palpitations, insomnia, osteoporosis were included. The included paper should have at least one Zang-fu organs therapeutic principle and the principle treatment must be TCM with detailed drug compositions listed. Priority of selection went to RCTs papers. For exclusion criteria, papers which had western medicine as principle treatment, did not have Zang-fu organs therapeutic principle and did not have detailed drug composition were excluded.2. Clinical Study2.1Treatment and evaluation The standard TCM Replenishing Kidney and Heart herbal formula for treatment of menopause from Professor Li Kunyin were used on56patients for7days (one dose per day). The Kupperman Index was applied for symptom relief evaluation while the Menopause-Specific Quality of Life survey (MENQOL) was used for quality of life evaluation. Surveys were conducted with patients before and after7days of treatment.2.2Inclusion and exclusion criteria.56cases of women aged45-55were included in the study from January2013to March2014from a TCM outpatient clinic. The eligible women must match the diagnostic criteria of menopause, fulfilled the TCM diagnostic principle of Kidney Yin-yang deficiency and had Heart related symptoms, aged45-55, with Kupperman index≥15and had not received any hormonal replacement therapy in the past3months. For those who were excluded, they were patients with complete oophorectomy, had ovarian cancer or ovary related diseases, already have or suspected to have breast cancer or estrogen relying cancer, had estrogen therapy in the past3months, had cardiovascular, respiratory, renal, liver, hematopoietic impairment, psychiatric unstable, had difficulty to coordinate with the research, allergic to the drug in our study, who were ineligible to the inclusion criteria, could not follow the prescription instruction, could not evaluate the effectiveness of treatment, incomplete patient’s information.Results1. Literature ReviewBy an electronic search on the China National Knowledge Infrastructure (CNKI) in between1994-2013, there were110eligible papers included which consisted of91different TCM herbal formulas.For the diagnostic principle, the5Zangs related principles had the highest frequencies in the order of following:Kidney related81times (43%), Liver related55times (30%), Heart related32times (17%), Spleen related18times (10%) and there was no Lung related principle (0%).For the therapeutic principles, the5Zangs related principles had the highest frequencies in the order of following:Kidney related42%, Liver related27%, Heart related19%, Spleen related12%, there was also no Lung related therapeutic principle (0%). When categorized the therapeutic princples in single or combined Zangs, the highest frequencies was Liver-kidney related 25%, the second was Kidney related20%, the third was Heart-kidney related12%.For the use of herbs, there were153different types of herbs in a total frequency of1213. There were53herbs which appeared≥7times in a total962frequencies, i. e.79%in the total number of herbs;101herbs appeared<7times, in a total of251frequencies which is21%of all herbs. The most frequently involved herbs was Danggui44times, Gangcao44times, Baishao41times, Fuling39times, Sanyurou36times、Shodiwang32times, Sanyao32times、 Mudanpi29times、Yinyanghou27times, Nuzhenzi27times, Zhimu27times, Suanzaoren27times. In those herbs≥7frequencies, the herbs with Heart and Liver meridian entry occupied the highest frequency which composed of23%each of all others Zang meridian entries, the second highest was those Kidney meridian entry which was20%, then was Spleen meridian entry18%, the least was Lung meridian entry0%.2. Clinical StudyAccording to the Kupperman Index, the mean score before treatment was23.46±8.98while after treatment was14.16±7.49. The difference of mean score before and after treatment was significant, P<0.05.According to the MENQOL, the mean score before treatment was57.16±20.94while after treatment was34.88±16.67. The difference of mean score before and after treatment was significant,P<0.05.ConclusionAccording to the literature review of recent20years, for the diagnostic principle of5-Zangs, Liver-kidney related was the most frequently used, Kidney related was the second, Heart-kidney was the third. For the therapeutic principle, Heart-kidney related was the third most frequently used which followed the first, Liver-kidney related and the second, Kidney related. For the use of herbs, the most frequently used herbs were Heart meridian entry and Liver meridian entry, Kidney meridian entry was the second most. It reflected in the treatment of menopausal syndrome for women, Heart-Kidney combination of treatment has a high rate of utilization. When consider the etiology of menopausal syndromes, the chief cause was the deficiency of kidney while there are usually mixed causes of excess and insufficient of Zangs’ functions. Therefore, the philosophy of replenishing Heart and Kidney has a valuable meaning in the study of menopausal syndrome. In the clinical study, the standard TCM Replenishing Kidney and Heart herbal formula for treatment of menopause from Professor Li Kunyin had significant effect on relieving menopausal symptoms and improving the quality of life of menopause women.