Meta-analysis Of Chinese Medicine Combined With Acupuncture And Moxibustion In The Treatment Of Delayed Menstruation

ObjectiveLate menstruation is a relatively common and frequent occurrence in gynecological diseases.The etiology and pathogenesis are more complex and changeable,making it difficult to cure for a long time.Indonesian women have a higher incidence of late menstruation.They often seek Indonesian herbal treatment and Western medicine treatment,but the healing effect is ineffective.This study conducted a meta-analysis by reading a large amount of literature on the post-menstrual period,and explored the advantages of modern acupuncture and moxibustion combined with TCM in the treatment of late menstruation,the characteristics of TCM and the research on the prescription of acupoints,and the characteristics of syndrome treatment,summarized the safety and clinical efficacy of acupuncture combined with TCM in the treatment of late menstruation.MethodsBy using Cochrane systematic review research methods,it includes data extraction analysis,methodological quality evaluation,result discussion and conclusion report.Also,the computer is a tool to retrieve data from various databases of China Knowledge Network（CNKI）,Wan Fang Data,China Biomedical Literature Database（Sino Med）,VIP Information Chinese Journal Service Platform（VIP）,Pub Med,and Embase.The research time is from January 1999 to June 2019.A comprehensive search for randomized controlled trials of acupuncture and Chinese medicine in the treatment of late menstruation.In the clinical observations included in the study,the observation group was acupuncture combined with TCM,and the control group was pure TCM.According to the specified inclusion criteria and exclusion criteria,documents are selected and data are extracted,and the"bias risk assessment tool"is used for quality assessment.Stata 15.0 software performs evaluation and analysis,and then continues to analyze and write papers.Results1.830 papers were detected which cure late menstruation with acupuncture combined with TCM,438 were journal articles,392 were master and doctoral theses.After reading the title and abstract,610 papers were discharged,220 papers were initially included for further ready and finally 16 Rcts papers that met the inclusion criteria were obtained after screening according to the inclusion criteria.According to the Cochrane 5.1.0 Reliance Risk Assessment,the quality evaluation is low-quality literature.2.16 Rcts all in chinese article,12 articles were from academic dissertations,4 articles were from journals and magazines.A total of 1090 cases of postmenstrual period study subjects were included in the analysis,including 546 cases in the treatment group of TCM combined with acupuncture and 544 cases in the control group of TCM.3.16 Rcts all with detailed inclusion and exclusion criteria;for the application method of random grouping,2 papers adopted the random number table method,and 14 papers mentioned the word"random"without describing the specific random allocation and the concealment method,it is impossible to judge whether the randomization method is correct;all the literature does not explain the blind method,the record and analysis of the cases of withdrawal and loss to follow-up.4.16 Rcts were included,the treatment time was 3 menstrual cycles,and there were 5articles mentioning follow-up time.5.The experimental group of 16 clinical randomized controlled trials:8 articles used TCM and acupuncture;4 articles used TCM and ear points;2 articles used TCM and moxibustion;1 article used TCM and acupoint application;1 article used TCM and acupoint embedding.The control group of 16 literature studies:all 16 Rcts were treated with TCM.6.The results of Meta analysis suggest that after treatment,the acupuncture group is better than the TCM group:（1）The difference in the total effective rate RR（95%CI）=1.17（1.11-1.25）,Z=5.19,P=0.000<0.05]the difference is statistically significant.（2）The differene in the total effective rate[RR（95%CI）=2.12-3.39,P=0.672>0.1]the difference is statistically significant.（3）The score of TCM syndrome[RR(95%CI=-8.57～-3.57,P=0.00<0.05]the difference is statistically significant.（4）The acupuncture group treatment is improving the menstrual cycle[RR(95%=0.94～-0.46,P=0.00<0.05]the difference is statistically significant.（5）TCM treatment significantly improved LH[WMD（95%CI）=-1.00（-1.26～-0.73）,Z=7.44,P=0.000<0.05 is statistically significant,indicating that LH in the acupuncture group was significantly lower than that in the TCM group;T[WMD（95%CI）=-0.25（-0.40～-0.11）,Z=3.41,P=0.001<0.05,there is a statistical difference,indicating that T in the acupuncture group is significantly lower than that in the TCM group;FSH[WMD（95%CI）=-0.22（-0.55～0.11）,Z=1.29,P=0.198>0.05,no significant difference;E₂[WMD（95%CI）=3.06（-6.81～12.94）,P>0.05,suggesting E₂ in the acupuncture group there is no significant difference with the TCM group;PRL[WMD（95%CI）=-0.38（-1.73～0.96）,Z=0.56,P=0.578>0.05,indicating that there is no significant difference between the acupuncture group and the traditional Chinese medicine group.（6）Extracting materials from the 16 included clinical randomized trials,TCM syndrome types are divided into 4 syndrome types,the syndrome types involved are kidney deficiency syndrome combined with stagnation of liver,cold blood stasis syndrome,phlegm-dampness syndrome,deficiency and cold syndrome.The syndrome types are mainly kidney deficiency syndrome;among the prescriptions of 16 clinical randomized trials,the most commonly used drugs are kidney-tonifying drugs.In the treatment of late menstruation,traditional Chinese medicines for invigorating the kidney,soothing the liver,relieving depression,and tonifying blood and promoting blood circulation are often used.7.16 Rcts using acupoints are divided into 4 treatment methods,and the frequency of use is:（1）Ear points:Spleen,Endocrine,kidney,adrenal glands,internal genitalia,ovaries,uterus,liver,hunger points and other ear points,heart,kidney,pelvic and abdominal points。adrenal glands,heart,pelvic and abdominal points.（2）Acupuncture:Taichong,Zhongji,Qihai,Taixi,Shenshu,Uterus,Sanyinjiao,Zhongwan,Ganshu,Guilaixue,Xuehai,Baliao,Zusanli,Pishu,Jiaoxin,Guan Yuan,Shishizui,Tianshu,Xiawan,Yin Lingquan,Feng Long.（3）Acupoint application:Shenque,Guanyuan,Yaoyangguan,Mingmen.（4）Acupoint embedding:Qihai,Sanyinjiao,Guilai,Xuehai.8.Involving 60 kinds of Chinese Medicine.There are eight kind of most frequently used such as Angelica,Poria,White Peony,Licorice,Atractylodes,Rehmannia,Bupleurum,Cyperus rotundus and etc.According to the efficacy of the medicines,they can be divided into blood tonic,diuretic and dampening medicine,invigorate the spleen and dry dampness,soothe the liver and relieve depression,regulate menstruation and relieve pain;the medicinal properties are warm and flat,taste bitter and sweet,and often return to the liver,spleen,and kidney channels.There are 4 commonly used drug combinations,and the core drug combinations are 4 after analysis.Respectively Angelica,Rehmannia glutinosa,Radix Paeoniae Rubra→Poria→Atractylodes macrocephala→Bupleurum,Cyperus rotundus.ConclusionThe META analysis of clinical research literature in the past 20 years shows that acupuncture and moxibustion combined with TCM in the treatment of late menstruation can reduce the score of TCM syndromes and improve the menstrual cycle.In terms of improving hormone levels,acupuncture and TCM have not shown significant advantages.