| Objective Postpartum lactation insufficiency has been a popular clinical topic in recent years.In view of establishing evidence-based management on postpartum lactation insufficiency in Traditional Chinese Medicine,Meta-analysis and systematic review were performed through analyzing clinical research literature in past 20 years.Methods Search strategy was established and review of various clinical databases were done.Inclusion and exclusion criterion were set.Clinical studies which fulfilled the criterion were screened and collected for further analysis.Systematic review The collected clinical studies were qualitatively analyzed using modified Jadad Score scoring system.Clinical studies of higher quality were further analyzed,using statistical software Review Manager 5.4.Distribution of TCM syndromes,frequency of acupoint and individual herb use were analyzed.Through establishing a comprehensive database in Excel,statistical analysis was done regarding the use of individual herb and acupoint.Results1.Meta-analysis A total of 2018 studies were collected from databases.Of which 46randomized-controlled trials were screened.87% of studies screened were of high quality.All 46 studies were randomized-controlled.In which 39(84.8%)of them used random number table.7 studies(14.9%)were described as “randomized” with details unavailable.Only 1 study mentioned the method of allocation concealment while others were not specified.Concerning the blind method,8 studies mentioned about application of blind method.Of which 3 employed double-blinded method without detailed explanation on methods and subjects.Follow-up analysis was present in 8.7% of all studies while absent in 91.3%.The follow-up interval were 1 month,42 days,2-4 months and “not specified”respectively.Regarding the drop-out and lost cases,9.1% of all screened studies reported zero drop-out rate.13% mentioned about lost cases / drop-out with illustration.Concerning safety of studies,81.8% reported absence of adverse event while 18.1% noted adverse event.All studies underwent statistical analysis on baseline characteristics which were comparable.(1)Traditional Chinese Medicine(TCM)versus Routine nursing care group-Total effective rate(1)TCM care group versus Routine nursing care group Total effective rate in TCM care group is higher than Routine nursing care.[OR=7.40,95%CI(5.70,9.60),p<0.00001](2)Chinese Medicine group versus Routine nursing care group Total effective rate in Chinese Medicine group was higher than Routine nursing care group.[OR=9.02,95%CI(5.33,15.26),p<0.00001](3)Tui Na group versus Routine nursing care group Total effective rate in Tui Na group was higher than Routine nursing care group.[OR=11.16,95%CI(6.48,19.22),p<0.00001](4)Combination of Chinese Medicine and Tui Na group versus Routine nursing care group Total effective rate in Combination of Chinese Medicine and Tui Na group was higher than Routine nursing care group.[OR=3.59,95%CI(2.22,5.82),p<0.00001](5)Acupuncture group versus Routine nursing care group Total effective rate in Acupuncture group was higher than Routine nursing group.[OR=11.33,95%CI(5.22,24.61),p<0.00001](2)TCM versus Routine nursing care group-Cure rate(1)TCM care group versus Routine nursing care group Cure rate in TCM care group is higher than Routine nursing care group.[OR=4.54,95%CI(2.87,7.50),p<0.00001](2)Chinese Medicine group versus Routine nursing care group Cure rate in Chinese Medicine group was higher than Routine nursing care group.[OR=16.24,95%CI(4.07,64.85),p<0.00001](3)Tui Na group versus Routine nursing care group Cure rate in Tui Na group was higher than Routine nursing care group.[OR=4.04,95%CI(1.33,12.25),p =0.01](4)Combination of Chinese Medicine and Tui Na group versus Routine nursing group Cure rate in Combination of Chinese Medicine and Tui Na group was higher than Routine nursing care group.[OR=2.72,95%CI(1.59,4.66),p=0.0003](5)Acupuncture group versus Routine nursing care group Cure rate in Acupuncture group was higher than Routine nursing care group.[OR=4.64,95%CI(1.92,11.18),p=0.0006](3)TCM versus Routine nursing care group-Breast feeding rate(1)Within postpartum patients with lactation insufficiency,subgroup analysis noted breast feeding rate was significantly higher in TCM group than Routine nursing care group.[OR=3.65,95%CI(2.60,5.12),p<0.00001](2)With all postpartum patients,subgroup analysis noted breast feeding rate was also higher in TCM group than Routine nursing care group.[ OR=4.24,95%CI(2.84,6.34),p<0.00001](4)TCM versus Routine nursing care group-degree of breast fullness TCM group versus Routine nursing care group Degree of breast fullness in TCM group was higher than Routine nursing care group.[SD=-1.68,95%CI(-1.81,-1.55),p<0.00001](5)TCM versus Routine nursing care group-Time of initiating lactation TCM group versus Routine nursing care group Time of initiating lactation in TCM group was earlier than Routine nursing care group.[SD=-1.78,95%CI(-1.95,-1.60),p<0.00001](6)TCM versus Routine nursing care group-Serum prolactin level(1)Postpartum serum prolactin level day 3-5TCM group was higher than Routine nursing care group.[SD=0.44,95%CI(0.27,0.60),p<0.00001](2)Postpartum serum prolactin level day 6-7TCM group was higher than Routine nursing care group.[SD=1.28,95%CI(0.91,1.65),p<0.00001]2.TCM syndrome distribution in postpartum lactation insufficiency A total of 192 randomized-controlled studies were recruited based on inclusion and exclusion criterion.(1)Common TCM syndrome distribution Deficiency of Qi and blood(46.4%),Liver Qi stagnation(34.5%),Stagnation of phlegm in lung(10%)(2)Common treatment modalities Chinese Medicine(29.2%),Tui Na(23.4%),Chinese Medicine and Tui Na combination(16.1%)3.Distribution and Frequency of acupoints in treatment of postpartum lactation insufficiency(1)The 20 commonest acupoints encountered are Shanzhong,Rugen,Shaoze,Zusanli,Pishu,He Gu,Taichong,Sanyinjiao,Qimen,Ganshu,Zhongwan,Neiguan,Zhongfu,Wuyi,Jianjing,Yingchuang,Tianchi and Geshu.(2)The commonest meridians are Stomach meridian,Conception vessel,Bladder meridian,Small intestine meridian,Spleen meridian,Liver meridian,Pericardium meridian,Large intestine meridian,Kidney meridian,Lung meridian,Gallbladder meridian,Governor vessel,Heart meridian and Triple energizer meridian.(3)The 10 commonest Auricular points are Endocrine,liver,Chest,Shenmen,Stomach,Mammary gland,Subcortex,Sympathesis and Gallbladder.4.Distribution and Frequency of Chinese medicines in treatment of postpartum lactation insufficiency(1)The 20 commonest herbs are Chinese angelica,Astragalus,Wangbuliuxing,Tongcao,Codonopsis,Malayan pangolin,Atractylodes and Szechwan lovage rhizome,Bupleurum and Hupeh Biriope root tuber,licorice,East china globethistle,Playcodon,Baishao,Processed rehmannia root and Lulutong,Common motherwort herb,Loofah,Mutong,Snakegourd root,Poria and nutgrass galingale rhizome,Ginseng and Immature tangerine fruit.(2)The meridians,based on the 20 commonest acupoints encountered,are liver meridian,followed by stomach meridian and spleen meridian.Others include lung meridian,Heart meridian,Gallbladder meridian,Bladder meridian,Kidney meridian,Pericardium meridian,Small intestine meridian and Triple energizer meridian. (3)The Nature,based on the 20 commonest herbs encountered,are mostly neutral followed by slightly cold and warm.As for the flavor,the commonest one is bitter,followed by sweet and acrid.Conclusion1.Meta-analysis of TCM literature in the past 20 years regarding postpartum lactation insufficiency showed that the cure rate and total effective rate in treating postpartum lactation insufficiency was higher in TCM group compared with Routine nursing care group.TCM treatments included Chinese herbs prescription,Tui Na,Chinese herbs combine with Tui Na and Acupuncture etc.By applying TCM treatments,the degree of breast fullness and the breast feeding rate were improved among postpartum patients;the time of initiating lactation was shortened;Postpartum serum prolactin level at day 3-5 and day 6-7were increased.2.TCM syndromes distribution analysis of postpartum lactation insufficiency consist of Deficiency of Qi and blood,Liver Qi stagnation and Stagnation of phlegm in lung.Analysis of frequency of Chinese Medicines showed that Herb associated meridians are mainly liver,stomach and spleen.Nature and flavor of herbs are mostly neutral,bitter and sweet.Common herbs include Chinese angelica,Wangbuliuxing,Tongcao,Codonopsis,Malayan pangolin,Actractylodes,Szechwan lovage rhizome,Bupleurum,Hupeh liriope root tuber,licroice and East china globethistle.Literature suggests the use of Stomach meridian,Conception vessel and Bladder meridian as the core in acupuncture and Tui Na in treating postpartum lactation insufficiency.Common acupoints encountered are Shanzhong,Rugen,Shaoze,Zuzanli,etc,including locate and remote cavitation.Common auricular points are Endocrine,liver,Chest,etc. |
PDF Full Text Request