| ObjectiveDue to the geographical environment,climate and regional culture of the Lingnan region that covers the Southern part of China,the diseases,pathology and the constitution of residents in the region show relative characterisitics.In order to obtain clinical efficacy,those factors ought to be taken into consideration in the diagnosis and treatment process.The objective of this study is to explore the characteristics of the causes and pattern types of commonly seen TCM gynecological diseases in Hong Kong.Accordingly,the diagnostic methodology and treatment corresponding to the characteristics are to be explored.This aims to provide useful data for TCM practitioners in Hong Kong so as to help improve the clinical efficacy.MethodThis study adopts Delphi technique and conducted an expert consultation.As a qualitative research,the number of experts to be consulted was set to be 14.The inclusion criteria for the experts are clinical practitioners with TCM gynecology clinical experience of 15 years or above,and age 39 or above,or with last job title of assistant consultant or above in hospital.Data collection was conducted by two rounds of questionnaire consultation.In the 1st round,7 commonly seen TCM gynecological diseases were to be explored.The experts were requested to select the most commonly seen causes and pattern types of each disease.The cause of disease and pattern type options were set with reference to the 5th and 6th edition standard textbooks of TCM gynecology,“TCM Gynecology and Obstetrics”edited by Liu Minru and Tan Wanxin and the suggestion of individual expert in the study.In the questionnaire,the experts could provide option suggestion if they found the option list was inadequate.Experts were requested to rank the causes of disease and pattern types selected.In addition,the experts were asked to provide their opinions of the influences of the climate,living habit,diet and culture of Hong Kong on the causes and pattern types of the TCM gynecological diseases.The experts were also requested to share their experience in diagnosis and treatment for the diseases,and the corresponding prescriptions and medicinals that they frequently use.Upon collection of the 1st round questionnaires after the experts had finished,the data were processed to formulate an integrated ranking of the causes and pattern types of each disease which represented the comprehensive opinion of all the experts in the study.These integrated rankings were put into the 2nd round questionnaire.The experts were requested to rank the causes and pattern types of each disease for one more time,with reference to the integrated rankings provided.Upon collection of the completed 2nd round questionnaires,the data were analysed.The rankings of the causes of disease and pattern types,the commonly use prescriptions and medicinals were tabulated.The opinions were analysed and descriptive report was prepared.ResultsThe ages of the experts in the study range from 47 to 76,with TCM gynecology clinical experience for 22 to 51 years and clinical experience in Hong Kong for 10 to 39 years.According to the experts,the top 5 ranking of the most commonly seen causes and pattern types of each TCM gynecological disease are as follows:1.DysmenorrheaMost commonly seen causes of disease:moodiness,excessive cold diet,innate kidney qi deficiency,caught pathogenic cold,constitutional qi&blood deficiency.Most commonly seen pattern types:blood stasis due to qi stagnation,congealing cold with blood stasis,deficiency of qi&blood,cold-dampness stagnation,qi deficiency with blood stasis.2.Flooding and spottingMost commonly seen causes of disease:kidney qi degeneration during menopause,source qi weakness,overexertion and fatigue,moodiness,excessive worry.Most commonly seen pattern types:kidney yin deficiency,kidney qi deficiency,spleen deficiency,spleen deficiency and liver depression,blood stasis.3.Menopausal syndromeMost commonly seen causes of disease:moodiness,excessive worry,constitutional yin deficiency,temperament,overexertion and fatigue.Most commonly seen pattern types:liver depression and kidney deficiency,heart-kidney noninteraction,kidney yin deficiency,dual deficiency of kidney yin&yang,ascendant hyperactivity of liver yang.4.Vaginal discharge disease Most commonly seen causes of disease:constitutional spleen deficiency,caught pathogenic dampness,improper diet,overexertion and fatigue,caught dampness toxin.Most commonly seen pattern types:spleen deficiency with dampness-heat,spleen deficiency,dampness-heat pouring downward,yin deficiency with dampness,dampness-heat pouring downward in the liver meridian.5.Infertility Most commonly seen causes of disease:damage to the thoroughfare&conception vessels at age over 35,constitutional insufficiency,moodiness,constitutional fatness,improper diet.Most commonly seen pattern types:kidney qi deficiency,liver depression,phlegm-dampness,kidney yang deficiency,kidney yin deficiency.6.Vaginal bleeding during pregnancy,threatened abortion Most commonly seen causes of disease:constitutional insufficiency,overexertion and fatigue,constitutional qi&blood deficiency,having aggregation-accumulation,improper diet.Most commonly seen pattern types:kidney deficiency,deficiency of qi&blood,dual deficiency of spleen and kidney,kidney yin deficiency,blood stasis.7.Aggregation-accumulation Most commonly seen causes of disease:moodiness,excessive worry,constitutional spleen deficiency,improper diet,wind-cold assailing during menstruation or following childbirth.Most commonly seen pattern types:blood stasis due to qi stagnation,phlegm-dampness-stasis binding,blood stasis due to kidney deficiency,congealing cold-dampness,blood stasis with dampness-heat.The opinions of the experts demonstrate that the climate,environment,living and work habit,diet,social trend,culture of Hong Kong have significant influence on the causes and pattern types of the 7 TCM gynecological diseases in the study.The most prominent factors include that the influence of the hot and humid climate has been altered by the excessive use of air conditioning,severe pressure from work and study,moodiness,long working hours and short sleeping hours,staying up late,lack of exercise,unawareness of keeping warm,improper diet,late marriage and pregnancy planning,rare sexual activities of married couples,sexually open among youngsters,inadequate knowledge of female hygiene,etc.All the above-mentioned can be considered Hong Kong characteristics.Comprehensively,the most commonly seen pattern types of the diseases are liver depression and qi stagnation,kidney qi deficiency,kidney yin deficiency,spleen deficiency,phlegm-dampness,dampness-heat,cold-dampness and blood stasis.Among those,liver depression and qi stagnation,kidney qi deficiency,kidney yin deficiency and spleen deficiency are most significant.Therefore,regulating thoroughfare and conception vessels as the principle method of treating TCM gynecological diseases,the key is to regulate kidney,liver and spleen.The experts suggested some pattern types which are commonly seen in Hong Kong,but not included in TCM gynecology textbooks.These are:congealing cold with blood stasis,qi deficiency with blood stasis in dysmenorrhea;spleen deficiency and liver depression in flooding and spotting;liver depression and kidney deficiency,heart-kidney noninteraction,ascendant hyperactivity of liver yang,spleen deficiency and liver depression in menopausal syndrome;dual deficiency of spleen and kidney in vaginal bleeding during pregnancy,threatened abortion.These phenomenon depicts the actual clinical situation and the pattern type characterisitics of TCM gynecological diseases in Hong Kong.It is observed that in treating diseases,the experts select prescriptions and medicinals according to the patterns,following the rule of "principles,methods,formulas and medicinal".They always take into consideration that the constitution of Hong Kong residents are relatively weak and deficiency-excess complex.In order not to jeopardize the healthy qi,they usually use light dose and mild medicinals,avoiding pungent and hot items.The experts also use some“Lingnan medicinals”which are available only in local,and more suitable for the constitution of Lingnan residents.Moreover,since the sentimental,living and environmental factors have significant influence on the diseases,apart from the medicine treatment,living habit advice,counselling and personal hygiene advice are also very important.ConclusionThis study adopts Delphi technique and conducted an expert consultation,together with literature analysis,to explore the pattern types and treatment methods for commonly seen TCM gynecological diseases in Hong Kong.The study finds that dysmenorrhea,flooding and spotting,menopausal syndrome,vaginal discharge disease,infertility,vaginal bleeding during pregnancy,threatened abortion and aggregation-accumulation are commonly seen TCM gynecology diseases in Hong Kong.The causes and pattern types of these diseases demonstrate a discipline that they are significantly influences by the climate,work and living habit,diet,social trend and culture of Hong Kong.All the senior Hong Kong TCM practitioners who participated in the study as experts agree with this conclusion.The diagnosis and treatment methodology of the experts are also under the influence of Lingnan medical science. |
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