| ObjectiveHong Kong belongs to the Lingnan region that covers Southern parts of China,and has its own unique experience in the practice of TCM but systematic data and records are rarely found.This study selected Chiu Siu Ping as the prestigious example of the Hong Kong TCM Gynecology.She graduated from the Guangzhou University of Chinese Medicine,and was a student of Luo Yuan Kai.Chiu Siu Ping has actively participated in the establishment of TCM tertiary institutions in Hong Kong as well as the formation of regulatory and registration system for TCM practitioners.She immigrated to Hong Kong in the 1970s,'and has practiced in the private sector for nearly 50 years.In this study,we set out to compare the fertility methods between Luo Song Ping and Chiu Siu Ping,to manifest how tertiary educated successor implements the mentor' s teaching in local region.To study in depth the pathogenesis and clinical features of common causes of infertility in Hong Kong with the ultimate aim to provide a platform for future integration between TCM and Western medicine.In doing so,we also hope to provide useful and reliable data for TCM practitioners in Hong Kong so as to increase the fertility rate in infertile couples in the future.Affirm the effort made by Chiu Siu Ping in flourishing Lingnan Gynecology development in Hong Kong.MethodSelection of effective prescriptions1.ProvisionChiu Siu Ping summarized her experience in the treatment of infertility over the past 50 years and generalised them into various effective prescriptions.They are divided according to different disease categories that include the primary and secondary infertility,ovarian problems,polycystic ovary · syndrome,endometriosis,hyperprolactinemia and immune-mediated infertility.A total of 67 effective prescriptions were derived which are commonly used by Chiu Siu Ping in her clinical practice.These prescriptions were sorted and entered into a computer program for her daily practice.2 Screening and DeterminationThere were three levels of screening.Firstly,Chiu Siu Ping provided the prescriptions to the author who then consolidated them into a total of 67 effective prescriptions based on the composition of herbs under Chiu's direct guidance.Secondly,the quantity of herbs in each prescription was carefully documented by the author.Finally,all the 67 effective prescriptions were examined again and approved by Chiu Siu Ping.All the prescriptions were released to the public for the first time.3.ClassificationAfter detailed analysis,the 67 prescriptions were divided into 6 categories:2.8 prescriptions for ovulation disorders(TCM Menstrual Cycle Therapy),4 prescriptions for endometriosis,14 prescriptions for tubal and pelvic disorders,10 prescriptions for polycystic ovary syndrome,5 prescriptions for hyperprolactinemia,and 6 prescriptions for immune-mediated infertility.Please refer to Appendix I for detailed classification.Methods of statistical analysis1.The content of the 67 effective prescriptions was entered into a database using Data Mining as the blueprint,which examined characteristics and relationships of herbs-pairing.We used two statistical methods to analyse the data,namely Frequency Analysis and Association Rule(Apriori Algorithm).Data were entered into EXCEL spreadsheet for preliminary data processing and basic frequency analysis,which was performed using SPSS Clementine 12.0 association rule calculus.2.Using the same methods,the author compared the similarities and differences in infertility treatments between Lingnan Luo' s school and Hong Kong Chiu Siu Ping school.Results(1)Prescriptive characteristics generated from Association Rule1.The majority of medicines used were warming drugs as the essence of women;s health relies on blood;coldness on the other hand is not suitable for enhancement of blood circulation.2.The 20 pairs of most frequently used paired-herbs generated from the Association Rule were mostly related to Zang Liver.3.Tailor-made Approach:one of the most frequently used paired-herbs by Chiu Siu Ping were[Tusizi->Shanzhuyu(49.254%,75.758%)].As people in the Lingnan region usually suffers from insufficiency of Yin and Qi,Shanzhuyu was used to balance the hotness of Tusizi which fit the geographical needs.4.Mutual Dependence and Support between Yin and Yang:The two paired-herbs[Tusizi->Danggui(49.254%,63.636%)],or[Danggui->Tusizi(49.254%,63.636%)],illustrated the mutual dependence and support between Yin and Yan,as Danggui' s blood nourishing effect would be enhanced by Tusizi' s yan effect and vice versa.5.Liver-Blood Nourishing:the other pairs of most frequently prescribed paired-herbs generated by the Association Rule were[Baisha->Tusizi(55.224%,67.568%)],and[Danggui->Baisha(49.254%,63.636%)].These three herbs share a common characteristic,which is healing effect in the Liver and Spleen.6.Treating Root and Treating Appearance:The seventh most frequently prescribed paired-herbs by Chiu was[Shanzhuyu->Tusizi(41.791%,89.286%)].In this paired-herbs,the ability to consolidate Kidney-Essence of Shanzhuyu was enhanced by the kidney warming effect of Tusizi.The ninth most prescribed paired-herbs was[Shanzhuyu->Danggui(41.791%,67.857%)],the use of which further elaborated the Qi and Blood relationship as“Qi is the commander of Blood”and“Blood is the Mother of Qi”.(3)The similarities and differences between prescriptions by Chiu Siu Ping and Luo Song Ping.Chiu Siu Ping graduated from Guangzhou University of Chinese Medicine,and was a former student of Luo Yuan Kai.As his daughter and successor,Luo Song Ping naturally becomes a remarkable representative of Lingnan gynecology.After studying and comparing their prescriptions,the resultscan be summarized as follows.Similarities1.Drug-induced tasteSweet-based herbs were most frequently used,salty herbs were rarely used.Sour herbs were seldom used as well.2.Zang Fu and Meridian AffinityHerbs that have nourishing effects on the Liver and Kidney were commonly used,followed by those with a smilar effect on the Spleen.3.The Four Natures of herbsHerbs with warm and neutral nature were most frquently used.Using the warming herbs helps guide the energy of the Vital Gate;neutral herbs have less chance of increasing hotness in the body,and are less irritable to the Spleen and Stomach.Differences1.the most frequently used herbsLuo Song Ping:The top used herbs were Duzhong,Tusizi,Shanyao,Xuduan,Sangjisheng,Baizhu,Yujin,Danshen,Baishao and Nuzhenzi.Chiu Siu Ping:Frequently used Danshen,Baishao,Denggui,Tusizi,Shanzhuyu,Shanyao,Fuling,Xiangfu,Chuanxiaog,Zhigancao,Shudi,Guijia,Chishao and Zishiying.2.Herbs related to Releasing the stagnation of Liver-QiLuo Song Ping:The most frequently used is Yujin.Chiu Siu Ping:The most frequently used is Xiangfu.3.Herbs related to Uterus warmingLuo Song Ping:The most frequently used is Fupenzi.Chiu Siu Ping:The most frequently used is Zishiyin.4.Herbs-Pairing generated by Association RuleBoth Chiu and Luo used Tusizi as the most frequently associated herb.Luo Song Ping:Five herbs were most frequently used and were associated with each other;they were Duzhong,Tusizi,Xuduan,Sangjisheng and Shanyao,this usage emphasized the important internal linkage between Liver and Kidney in fertility.Chiu Siu Ping:Four herbs were most frequently used and were associated with each other;they were Tusizi,Shanzhuyu,Denggui and Baishao,this usage emphasized the dominant role of blood in the treatment of infertility.5.Luo' s prescriptions usually consisted of no more than 12 kinds of herbs.Chiu Siu Ping often prescribed more than 12 herbs in each prescription.It can be concluded that despite similarities between Chiu Siu Ping and Luo Song Ping in the selection of herbs,there were notable differences in the pairing of herbs and prescribing habits between Guangzhou and Hong Kong.(4)Chiu Siu Ping personal preference for herbs-pairingTwo Solstices Pill-consists of Nuzhenzi and Mohanlin,as they have to be collected at the time of summer solstice and winter solstice,it is also known as Two Solstices Pills.Immortals soup-this is a formula using two kinds of medicines bearing the word "Xian" which means "immortal".They are Xianmao and Xianningpi.The original composition of the formula also consists of Zhimu,Huangbai,Danggui,and Bajitian.Many TCM practitioners use this formula to treat menopausal problems.Chiu Siu Ping likes to use the Xianmao and Xianningpi together as a paired-herbs as she believes they have stimulatory effects on the sex glands.Zuojin Pill—this classic formula consists of two medicines only,namely,Huanglin and Wuzhuyu.Chiu Siu Ping modified it into new combinations and used Zhenzhu to replace Huanglin,as Huanglin' s nature is strongly bitter and strongly cold which is not suitable for Lingnan region as people mostly have weaker Spleen.Chiu used Zhenzhu with the same ratio as original formula of 6:1-30g of Zhenzhu with 5g of Wuzhuyu.Zhenzhu calms Liver and extinguishes wind and can be use for restoring the Yin.Shixiaosan—Chiu Siu Ping believes that most of the gynecological diseases are related to the circulation of blood.Shixiaosan consists of two kinds of herbs,Puhuang and Wulingzhi,a classic combination for clearing the stasis blood.Sichuan Chinaberry Powder—this classic prescription consists of Chuanlianzi and Yanhusuo,which not only promotes qi and smoothes the liver,but also improves the blood circulation to stop the pain.Chiu used it based on the principle of "Qi is the commander of Blood".(5)Combination of planning treatment according to diagnosis and illness1.EndometriosisChiu considers "Blood Stasis" and "Endogenous Dampness" as the key factors.Shixiaosan and Bai jiangcao were frequently used to promote qi and improve blood circulation to stop the pain.Her tactics can be concluded into four principles-Attack,Crack,Nourish,and Softening.Chiu applies these principles with adjustment to individual characteristics and the timing of menstrual cycles.2.Pelvic inflammatory disorderChiu Siu Ping always emphasises that TCM treatment should not be misled by western medicine,which tends to use antibiotics as the first line of treatment.This can be regarded as strongly cold medicine,which is not good for blood circulation.Chiu likes to dissipate and restore at the same time to get rid of pathogenic factors and regain the Genuine Qi.The most frequently used herb for this purpose was Yiyiren.Based on modern scientific research,she also frequently used Baibu and Kushen as paired-herbs to treat vaginitis.3.Polycystic Ovary SyndromeThe basis of Polycystic Ovary Syndrome is the deficiency of Kidney-Essence,which causes abnormal menstruation or amenorrhea.Chiu considers egg as the product of the Kidney-Essence,and if deficiency occurs,eggs cannot be produced on a regular basis.She focuses the treatment on Kidney-Yin and Kidney-Yan.Emphasis on the pathogenic factors such as endogenous dampness is always tied up with Blood Stasis.4.Improve the quality and quantity of eggs in IVF-ET Treatment.Chiu Siu Ping believes that TCM can help nourish yin and generate blood,which play a pivotal role in follicle development.Besides Kidney,Liver is another key factor in egg extraction as TCM herbs can relieve the stagnation of Liver-Qi.She starts the treatment from the 5th-13th days of menstrual cycle and names it as the“follicle Fomula",which consists of Nuzhenzi 15g,Mohanlian 15g,Sengdi 15g,Baishao 30g,Ziheche 10g,Zishiying 15g,Zhimu 10g,Huang bai 10g,Xianningpi 10g,Dangshen 15g,Baizhu 15g,Fuling 15g,Shechuangzi 15g,Maidong 10g,Sangshen 15g,Shanzhuyu 10g.This effective formula is inspired by Two Solstices Pill and Four Nobles Decoction.5.Inadequate endometrial thickness after IVF-ET TreatmentFor the problem of insufficient endometrial thickness,Chiu Siu Ping targets on Kidney-Qi and warming up the Du Meridian in order to provide a cultivating base for the "seed".Her "Luteal Formula" is composed of Xuduan 15g,Duzhong 15g,Ejiao 10g,Baishao 30g,Tusizi 30g,Ziheche 10g,Roucongrong 15g,Xianningpi 10g,Dangshen 15g,Baizhu 15g,Shanyao 15g,Sangjisheng 30g,Sangshen 15g,and Gancao 6g.Chiu is inspired by Shoutai pills which aims to strengthen the uterus and promote blood circulation.6.Ovarian Hyperstimulation Syndrome(OHSS)Chiu Siu Ping emphasizes the basis of OHSS is on the Spleen and Kidney.She designed an effective prescription to reinstate the Spleen-Qi,to remove the pathogenic water,and to prevent miscarriage.Her effective prescription is Danshen 15g,Baizhu 15g,Fuling 15g,Chenpi 6g,Baishao 30g,Chuanxiong 10g,Muxiang 6g,Zisuye 10g,Cangzhu 10g,Wuyao 10g,Shengjiangpi 10g,Dafupi 15g,which can be used to compliment Western treatments.7.Prevention of miscarriage in IVF-ET TreatmentBased on the vital role of Kidney in fertility,Chiu Siu Ping formulates her effective prescription which is composed of Dangshen 15g,Baizhu 15g,Shanyao 15g,Xuduan 15g,Duzhong 10g,Tusizi 30g,Nuzhenzi 15g,Baishao 30g,Sangshen 15g.This combination of herbs can restore the Kidney and generate Blood for preventing miscarriage.Conclusion1.In the management of infertility,Chiu Siu Ping manifests the Lingnan gynecology spirits in the following ways-emphazing the vital roles of Kidney and Spleen,using light and mild prescriptions,treating root and treating appearance,eliminating the Blood Stasis and Endogenous dampness.Using the Apriori arithmetic operation,it can be concluded that Chiu has five treatment principles:? Relieving and Calming the Stagnation of Liver-Qi,? Preserving the Kidney-yin,Essence and Blood,?Maintaining the vital function of Kidney and Spleen that in turn preserves Essence,?Eliminating the Blood Stasis and promoting Qi circulation,? Dispersing Endogenous Dampness and detoxification.2.Chiu Siu Ping emphasizes on the Liver.She uses different ways to calm and smoothe the Liver,for example,she would relieve the stagnation of Liver-Qi and the upward Flaming of Liver-Fire.Based on the theory of five elements,she would also promote the mutual nourishment of the liver and Kidney.In order to secure regions not affected by illness,she would first strengthen the Spleen.3.The Kidney-yin,Essence and Blood Preservation method can be readily seen in herbs-pairing as exemplified by Guiji with Tusizi,and the use of Zhogui Bolus as a prototype in the composition of various effective prescriptions.4.The Kidney and Spleen play a pivotal role in fertility.5.The method of Elimination of Blood Stasis and Promotion of Qi Circulation.Chiu Siu Ping prefers to use herbs with cold or neutral nature to avoid worsening of the Blood Stasis.Dengshen can be used in multiple settings.The combination of dissipation and restoration is the key of this method.6.The method of Dispersing Endogenous Dampness and Detoxification.Chiu Siu Ping rarely uses hot nature herbs for Endogenous Dampness but would use those herbs that can increase bowel movement to expel the endogenous factors out of the system.She tends to use herbs with synergistic effects for herbs-pairing.7.Chiu Siu Ping has worked in Hong Kong for nearly 50 years and has established expertise in integrating Western medicine and TCM with Western diagnostics.It is manifested in treating Endometriosis,Polycystic Ovary Syndrome,hyperprolactinemia,Pelvic inflammatory disorder and immune-mediated infertility.She formulates a series of Effective Prescriptions which form an important base for future development in the management of infertility.8.Diagnostic algorithm-Chiu Siu Ping frequently asks three diagnostic questions:"Do you dream frequently?”to diagnose Endogenous Fire;"Do you feel thirsty often?" to diagnose Endogenous Dryness;and "Do you have any lower abdominal pain?" to diagnose Blood Stasis and Endogenous Dampness.In summary,by providing a detailed account of infertility treatment by Chiu Siu Ping in Hong Kong,this study extends and supplements the knowledge and experience of the traditional Lingnan Gynecology.As Hong Kong has a unique culture of integration between Western and Chinese Medicine,the result of this study might help practitioners specialized in infertility to improve the clinical outcome in the future. |
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