| Objective: There are two purposes in this study.On the one hand,we investigated the related factors of luteal insufficiency infertility(liver depression and kidney deficiency)by questionnaire,and then combined with literature analysis to study the mechanism of liver depression,kidney deficiency and ovarian accumulation and diarrhea.On the other hand,the evidence based medicine is used for clinical research.Lian’s integrated traditional Chinese and Western medicine therapy is used to treat infertility due to liver depression,kidney deficiency and luteal insufficiency.The efficacy and safety of the therapy are evaluated through related indicators.Methods: A self-designed questionnaire was used to investigate 216 cases of LPD infertility(liver depression and kidney deficiency)diagnosed in Beijing Guodu Hospital and Taiwan new building hospital gynecology outpatient or inpatient department from March 2014 to May 2017.The basic information of individual and LPD infertility related information were collected,and the correlation between them and TCM syndrome type was analyzed by SPSS22.0.60 cases of LPD patients hospitalized in Beijing Guodu Hospital according to the random number table is divided into the control group orally combined with normal luteal progesterone capsules 2 combined treatment group and simple oral progesterone capsule,the control group was given oral progesterone capsule treatment,the treatment group in the control group on the basis of Jian Fang No.2 decoction of Chinese medicine oral corpus luteum.A total of 3 courses of treatment were treated.Collect the patients before and after treatment the serum progesterone level of P,corpus luteum insufficiency curative effect,TCM syndrome score,menstrual symptoms,endometrial thickness,BBT type,implantation area index(PNI)and high temperature(HPS),pregnancy score and other information,and record all adverse reactions occurred in the course of the study.All the research data are set up according to the standard of Excel,and the statistical analysis and comparative study are carried out by SPSS22.0 software package.Results:A.The results of the mechanism study:Among 216 cases of LPD infertility,190 were Han(87.96%),26 were ethnic minorities(12.04%),Han: ethnic minorities = 7.4:1,suggesting that the LPD infertility patients(liver depression and kidney deficiency syndrome)were mainly Han nationality.Marriage within 5 years in 7 cases(3.24%),209 cases of marriageable age greater than 5 years(95.43%).LPD infertility(liver and kidney deficiency syndrome)in patients with different occupation groups at different rates,in order to housewives,office workers,businessmen,doctors,teachers,civil servants,farmers,workers,including housewives,office workers,businessmen,doctors and the incidence is significantly higher than other occupation,low incidence of the farmers and workers.The age of onset of LPD infertility(liver depression and kidney deficiency)is the highest among 36~40 years old,indicating that the occurrence of LPD infertility(liver depression and kidney deficiency syndrome)increases with age.Patients with LPD infertility(liver qi deficiency and kidney deficiency syndrome)had the longest course of disease in 3~6 years,accounting for 86.51%,the course of disease was less than 3 years and less than 6 years.LPD infertility(liver qi stagnation of the kidney syndrome)patients with more culture in high school-Junior College,as well as primary school-junior high school.LPD infertility(liver and kidney deficiency syndrome)in patients with pregnancy data reflect several cases,some patients with pregnancy and birth were 0 for primary infertility patients,more than the number of times of pregnancy production,that such patients have abortion phenomenon.LPD infertility(liver and kidney deficiency syndrome)in patients with menstrual abnormalities were sorted according to the percentage of emergence: menstruation(42.59%),intermenstrual bleeding(33.33%),menstruation(25%),menostaxis(18.52%),(15.74%)has no regular menstruation,menorrhagia hypomenorrhea,(12.96%)(7.41%)(5.56%),dysmenorrhea,amenorrhea(3.24%).LPD infertility(liver and kidney deficiency syndrome)clinical symptoms were irritability,premenstrual breast pain,heave a deep sigh,hyposexuality,Yaoxisuanruan,night urination,urine clear long,tooth loss,tinnitus or deafness,shaking face foot superficial,chest tightness,insomnia,abdominal distension,dry mouth,thirst,dizzy belching and loose stools.B.The results of clinical study1.Pregnancy:Of the 59 patients in the treatment group,40 patients had successful pregnancy,the clinical pregnancy rate was 67.80%,10 cases of spontaneous abortion,the rate of spontaneous abortion was 16.95%,the extrauterine pregnancy rate was 0%,the rate of non pregnancy was 15.25%.Of the 60 patients in the control group,only 12 patients had successful pregnancy,the clinical pregnancy rate was 20%,24 cases of spontaneous abortion,the rate of spontaneous abortion was 40%,the extrauterine pregnancy rate was 3.34%,the rate of non pregnancy was 36.67%.After statistical analysis,there were significant differences in the clinical pregnancy rate and spontaneous abortion rate between the two groups(P<0.01).The treatment group had a significantly higher pregnancy rate and a lower spontaneous abortion rate than the control group.2.The comprehensive curative effect of TCM syndrome:The total effective rate of combined treatment group(94.92%)was significantly higher than that of single progesterone capsule control group(83.33%).P<0.05,combined treatment group showed better improvement in TCM syndrome compared with simple progesterone capsule control group.In 119 cases of LPD infertility with liver depression and kidney deficiency syndrome,according to TCM syndrome integral efficacy criteria,59 cases in the treatment group were cured,44 cases(74.58%),8 cases markedly effective,13.56%,effective 4 cases,6.78%,invalid 3 cases,5.08%,and the total effective rate 94.92%.In the control group,16 cases were cured,26.67%,22 cases,36.67%,12 effective,20%,10 ineffective,16.67%,and the total effective rate was 83.33%.The rate of recovery and total efficiency was significantly higher in the combined treatment group than in the control group with simple progesterone capsule,P<0.05,the difference was statistically significant.3.BBT,PNI,HPS improvement:In 119 cases of liver kidney deficiency type LPD patients with infertility,after treatment of basal body temperature type I 40 cases,accounting for 67.80%,the control group of 12 cases,accounting for 20%,compared between the two groups,P<0.01 group was significantly higher than that in the control group treated temperature type I cases in the comparison,the difference was statistically significant.After treatment,there were 8 cases of type III,13.56% in the treatment group and 22 in the control group,accounting for 36.67%.Compared with the two groups,P<0.01 and basal body temperature type III cases were significantly less than those in the control group,the difference was statistically significant.In 119 LPD infertility patients with liver depression and kidney deficiency,the PNI increased from 63.47 ± 6.95 to 90.02 ± 7.11 after treatment,and the difference was statistically significant in the same group before and after treatment.The difference between the two groups was statistically significant.After treatment,PNI increased from 64.54 ± 6.02 to 81.30 ± 6.23 in the control group,and the difference was statistically significant before and after treatment in the same group,P<0.05.After treatment,there was a significant increase in the level of PNI in the P<0.01 group and the combined treatment group compared with the two groups.The difference between the two groups was statistically significant.Among 119 LPD infertility patients with liver depression and kidney deficiency,the HPS score increased from 3.87 ± 1.26 to 7.94 ± 1.35 after treatment in the combined treatment group.P<0.01 in the same group was compared before and after treatment.The HPS score of simple progesterone capsule in the control group increased from 3.91 ± 1.19 to 5.16 ± 1.40,and was compared with that of the same group before and after treatment,P<0.05.After treatment,compared between the two groups,the level of HPS in the combined treatment group was significantly higher than that of the control group in the combined treatment group(P<0.01).4.menstrual symptom score:In 119 LPD infertility patients with liver depression and kidney deficiency syndrome,the total score of menstrual symptoms decreased from 1.27 to 0.83 in the treatment group after treatment.There was a statistically significant difference in P<0.01 between the two groups before and after treatment in the same group.There was a significant difference between the two groups(P<0.01).After treatment,the score of menstrual symptoms in the control group decreased from 9.41 ± 1.63 to 5.46 ± 1.75,and the difference was statistically significant before and after treatment in the same group,P<0.05.After treatment,the comparison between the two groups,P<0.01,the treatment group was significantly lower than the control group,the difference was statistically significant.5.Progesterone levels in the midluteal period:The level of serum progesterone P increased from 19.62 ± 11.34 to 75.48 ± 12.19 in the treatment group after treatment,and compared with the same group before and after treatment,P<0.01.The serum progesterone P level was increased from 19.79 ± 12.05 to 56.17 ± 11.53 after treatment with simple progesterone capsule in the control group,and P<0.01 in the same group before and after treatment.After treatment,the comparison between the two groups,P<0.01,the combined treatment group was significantly higher than the oral control group with simple progesterone capsule.6.B ultrasonic detection of endometrium thickness during ovulation period:In 119 LPD infertility patients with liver depression and kidney deficiency,the endometrial thickness increased from 0.88 ± 0.17 cm to 1.14 ± 0.13 after treatment in the combined treatment group.P<0.01 in the same group was compared before and after treatment.The thickness of endometrium was increased from 0.87 ± 0.25 to 0.99 ± 0.06 after treatment with simple progesterone capsule in the control group,and the same group before and after treatment,P<0.05.After treatment,the comparison between the two groups,P<0.01,the combined treatment group was significantly thicker than the simple corpus luteum capsule oral control group.7.The effect of luteal insufficiency:In 119 cases of LPD infertility with liver depression and kidney deficiency,according to the criteria of curative effect of luteal insufficiency,59 cases were cured,40 cases(67.80%),6 cases markedly effective(10.17%),4 cases effective,6.78% cases,9 cases ineffective,15.25% cases,and the total effective rate 84.75%.60 cases in the control group were cured in 12 cases,accounting for 20%,18 cases,30%,effective 8,13.33%,22 ineffective,36.67%,and total effective 63.33%.The recovery rate and total effective rate of the two groups were significantly higher than those in the control group,P<0.05,the difference was statistically significant.8.Security:There was no adverse reaction between the combined treatment group and the oral control group with simple progesterone capsule during the treatment.Conclusion:A,the mechanism aspect1.LPD infertility(liver qi stagnation and kidney deficiency syndrome)the main incidence of Han,which may be related to the regional distribution of the nation.2.with the increase of age,patients may be due to sexual life after marriage led to a rise in the incidence of kidney deficiency.Traditional Chinese medicine believes that the loss of renal sperm after marriage is one of the important causes of the disease.Acquired kidney essence depletion also affects the kidney enrichment,lead to disease,which is consistent with the description of this disease in Huangdi neijing.In addition,married for a long time have not pregnant patients suffer more from the Chinese traditional culture the concept of practice,such as "unfilial" and "male complex" pressure,more easily hurt in emotion,resulting in stagnation of liver qi.We speculate that the longer age LPD patients with infertility,kidney deficiency with liver stagnation syndrome type incidence or more,but requires a large sample investigation to clear.3.LPD infertility(liver qi deficiency and kidney deficiency syndrome)patients may be closely related to the law of life.Behind many housewives men are the breadwinners,and they often need to go out and socialize,housewives can not be economically independent,often trapped in the family chores,they toil and worry for her husband,Yin Jing Long friction,causing kidney deficiency and liver Qi stagnation.Workers and businessmen generally have a lot of pressure on their daily life and work.They stay up late or get up early.They suffer from liver and kidney injury due to lack of sleep,resulting in dysfunction of cerebral cortex and reproductive axis,leading to the occurrence of LPD.Doctors and nurses had a large labor intensity and were trapped by the dual pressure of family and work.In recent years,doctors and nurses were more involved in the frequent conflicts between doctors and patients,resulting in liver depression and kidney deficiency.The work of teachers and civil servants is more stable,the life is more regular and the pressure is small,which may lead to the lower incidence of the disease.Farmers and workers may not choose to go to third grade hospitals because of their busy livelihoods and poor economy.The lower incidence of this study is to be discussed.4.the incidence of LPD infertility(liver qi deficiency and kidney deficiency syndrome)has a positive correlation with age growth,which is in line with the law of gradual failure of renal sperm with age.5.more than 6 years duration in patients,probably because of Jiuzhibuyu,giving up treatment and no fertility requirements,probably because the turn to reproductive center assisted reproductive technologies such as IVF treatment,so few.In the course of 1~2 years LPD patients belonging to the liver and kidney deficiency syndromes are few,probably because patients after illness also need to take time for a long time and after treatment but no cure,can lead to the stagnation of liver qi.6.There is a certain correlation between the occupational composition and the educational status of the patients in this group.LPD infertility(liver depression and kidney deficiency)patients in the family housewives and office workers are mostly in primary school and junior high school,while businessmen and medical education are mostly in high school and junior college,suggesting that women with lower education level and higher occupational pressure are more likely to suffer from liver depression and kidney deficiency.7.There is a certain correlation between the occupational composition of this group and the region.The incidence of occupational disease in Beijing and Taiwan is different,which is caused by many factors,such as economic,political,legal,policy and social factors.The Taiwan office workers may have been suffering from stagnation and kidney deficiency due to staying up late and irregular diet.In recent years,Taiwan merchants may have more syndrome of liver depression and kidney deficiency because of the influence of global economic factors in recent years.In recent years,the economy is sometimes too cold and sometimes overheated.When the economy is hot,work and rest are irregular,overworked and late for work.In Beijing,it is difficult to collect the incidence of real workers because of legal policies and cultural taboos.However,because of the high housing prices,the gap between the rich and the poor,and the more frequent men staying up late in the recent years,the housewives who are more traditional and conservative are more likely to form the syndrome of liver depression and kidney deficiency.The doctors and nurses in hospital because of frequent medical trouble,work pressure and other physical and mental suffering,often need to stay up late to work overtime and other factors,will also lead to a high incidence of liver and kidney deficiency syndrome.8.LPD infertility(liver qi stagnation of the kidney syndrome)patients with depression introversion,irritability,anxiety and other emotional and personality characteristics,which has a negative impact on the psychology,On the other hand,negative psychological and emotional factors will aggravate the condition,causing the disease to be difficult to cure.This is consistent with the theory of Chinese medicine seven pathogenic,but also explains the importance of psychological therapy.9.some patients with kidney deficiency liver depression,may be caused by congenital deficiency.While some patients may be due to pregnancy,frequency of sexual intercourse frequency,happy as a result of injury of kidney yin and kidney yang.These are in line with the reality of social life,which highlights the importance of kidney deficiency in this disease.10.LPD causes irregular menstruation in clinical still more common,but mainly with abnormal menstrual cycle and interphase bleeding as the main clinical manifestation.Personally think that this is the true Yin damage due to kidney yang deficiency and liver qi stagnation for too long.When the true Yin is damaged,the abnormal menstruation appears earlier than the general symptoms.B.Clinical research:Treatment No.2 herbal medicine combined with healthy luteal progesterone capsules compared with treatment only using progesterone capsules,it can effectively improve the liver and kidney deficiency in LPD patients with infertility clinical pregnancy rate and reduce the rate of spontaneous abortion,can effectively relieve or eliminate symptoms of kidney deficiency syndrome of stagnation of liver Qi LPD infertility patients,can effectively improve the BBT type patients,can effectively improve the patients with PNI and HPS integrals,effectively reduce the liver and kidney deficiency LPD infertile patients menstrual symptoms,more can effectively increase the liver and kidney deficiency of serum progesterone level of P LPD in patients with infertility,more effective liver and kidney deficiency LPD patients with infertility endometrial thickness increased,more effective in the treatment of liver and kidney deficiency syndrome type LPD infertility patients with luteal dysfunction symptoms.In conclusion,this study is of high clinical,academic,economic and social value,which is worthy of further study. |
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