A Meta-Analysis Of The Treatment Of Menopause Syndrome By Nourishing The Liver-Yin And Kidney-Yin And The Clinical Effect Of The Addition And Subtraction Of Guishen Wan

Obsjective:In the first part of this study,through the meta-analysis of the relevant literature on the treatment of menopause syndrome by nourishing the liver and kidney,this study further compares the efficacy and safety of traditional Chinese medicine which can nourish the liver and kidney with hormone in the treatment of this disease.In the second part,through the application of the addition and subtraction of Guishen Wan on treating menopause syndrome of deficiency of liver-yin and kidney-yin and loss of essence and blood,observe and evaluate it's efficacy and safety,so as to provide evidence-based and clinical-based prevention and treatment of menopause syndrome.Methods:1.Meta analysis: all randomized controlled trials of nourishing the liver and kidney therapy for menopause syndrome were searched in CNKI,Wanfang Data,VIP and Pubmed,and the literatures were screened strictly according to the inclusion criteria and exclusion criteria.Then complete the information extraction,use Cochrane bias risk assessment tool to assess the bias risk of the literature included in the meta-analysis,and use the Review Manager 5.3 software provided by Cochrane Collaboration Network for meta-analysis.2.Clinical observation: 47 cases of menopause syndrome with deficiency of liver-yin and kidney-yin and loss of essence and blood were included in this study.General data,Modified Kupperman Score,Menopausal Syndrome(TCM)Rating Scale,Menopausal-Specific Quality of Life(MENQOL)score and serum sex hormone(FSH,LH,E2)were collected before treatment.After taking the addition and subtraction of Guishen Wan for 12 weeks,the above indexes were collected again to evaluate the efficacy and safety.Results:1.Meta analysis: 11 articles were included,including 818 cases of menopause syndrome.Meta analysis results:(1)In the treatment group(nourishing the liver and kidney group),Kupperman score(WMD=0.08,95%CI[-0.41,0.57],P=0.75),FSH level(WMD =-1.51,95% CI [-4.76,7.79],P= 0.64),LH level(WMD =-0.85,95% CI [-3.75,2.05],P= 0.56),E2 level(SMD = 0.20,95% CI [-0.26,0.66],P= 0.39),and marked improvement rate of TCM syndrome integral scale(RR = 1.16,95% CI [0.86,1.57],P = 0.34)were all higher than that of the control group(hormone group),P>0.05,there was no statistical difference.(2)In the Kupperman score scale total effective rate(RR=1.11,95% CI [1.02,1.20],P=0.02)and TCM syndrome integral scale total effective rate(RR = 1.09,95% CI [1.01,1.18],P= 0.04),Kupperman score scale marked improvement rate(RR = 1.28,95% CI [1.01,1.61],P= 0.04),the treatment group was significantly higher than the control group,the difference was statistically significant.(3)The incidence of adverse reactions in the treatment group was lower than that in the control group(RR = 0.32,95% CI(0.18,0.58),P=0.0002)The difference was statistically significant.2.Clinical observation:(1)Total clinical effective rate:The clinical symptoms of 47 cases of menopause syndrome with deficiency of liver-yin and kidney-yin and loss of essence and blood were relieved after 12 weeks' treatment with the addition and subtraction of Guishen Wan.The clinical control rate was 4.26%,the marked improvement rate was 40.42%,the effective rate was 48.93%,the ineffective rate was 6.38%and the total clinical effective rate was 93.62%.(2)Modified Kupperman Score:After treatment,the total score of Modified Kupperman Score(9.49±4.30)was significantly lower than that before treatment(27.43±10.37),P<0.01.After treatment,the scores of all symptoms of Modified Kupperman scale were significantly lower than that before treatment(P<0.05),and the symptoms of tidal fever and sweating were relieved most obviously,the total effective rate was 95.74%;according to the severity of the patients' condition,the therapeutic effect was mild(100%)> moderate(68.97%)>severe(50%).(3)Menopausal Syndrome(TCM)Rating Scale:After treatment,the score of Menopausal Syndrome(TCM)Rating Scale(59.21±21.00)was significantly lower than that before treatment(80.36±21.62),P<0.01.(4)Menopausal-Specific Quality of Life(MENQOL):After treatment,the score of Menopausal-Specific Quality of Life(MENQOL)(37.04 ± 21.34)was significantly lower than that before treatment(83.49±41.85),P<0.01.After treatment,the symptoms of vasomotor dimension,psychological dimension,physiological dimension and sexual life dimension were significantly released(P<0.01).(5)Serum FSH,LH,E2: the level of LH after treatment(30.16±18.21)was lower than that before treatment(32.08±18.54),P>0.05,there was no significant difference.The level of FSH after treatment(49.25±35.72)was significantly lower than that before treatment(64.11±37.43),and the level of E2 after treatment((66.46±43.14)was significantly higher than that before treatment(33.63±30.46),the difference was statistically significant(P< 0.01).Conclusion:1.The curative effect of traditional Chinese medicine of nourishing liver and kidney on menopause syndrome is definite,and the safety is higher than that of hormone therapy.However,due to the small amount and low quality of literature included in this meta-analysis,there may be some deviation in results.It is expected that more multi-center,large-sample and high-quality clinical studies will be carried out to further verify the effectiveness and safety of evidence-based evaluation results.2.The addition and subtraction of Guishen Wan can obviously alleviate the clinical symptoms of the menopause syndrome of deficiency of liver-yin and kidneyyin and loss of essence and blood,improve the life quality of the patients,improve the level of reproductive hormones.It's curative effect is accurate,reliable and safe.It is worthy of clinical application.