Rules and Characteristics of TCM Treatment Prescriptions for Patients with Decreased Ovarian Reserve

Ying WANG, Guoqiang LIANG, Xuanyi CHEN

Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou 215009, China

Abstract [Objectives] To analyze the characteristics and rules of traditional Chinese medicine (TCM) in the treatment of decreased ovarian reserve (DOR) in Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine. [Methods] A total of 107 patients with DOR in Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine were selected for sorting, and the usage, classification, nature, taste and meridian homing of the used drugs were statistically analyzed. [Results] A total of 107 patients were included in this stud and a total of 189 flavors of TCM are used. The total frequency of drugs was 4 345 times, and a total of 535 prescriptions were issued. The top five frequency of drug use were 2 261 times (50.04%) of Paeoniae Radix Alba (Cynanchum otophyllum Schneid.), 2 037 times (46.88%) of Corni Fructus (Cornus officinalis Sieb. et Zucc.), 1 818 times (41.84%) of Rehmanniae Radix Praeparata [Rehmannia glutinosa (Gaertn.) Libosch EX Fisch.et Mey.], 1 610 times (37.05%) of Guiban [Chinemys reevesii (Gray)], and 1 303 times (29.99%) of Uncariae Ramulus Cum Uncis (Uncariar hynchophylla Miq. ex Havil.). Kidney deficiency syndrome accounted for the largest proportion at 51.40%, and the use frequency of tonic drugs accounted for the highest at 50.64%; heat-clearing drugs and qi and blood-boosting drugs separately accounted for 19.24% and 17.39%; the top 3 medicinal tastes are sweet (52.02%), pungent (20.71%) and bitter (20.32%); medicinal properties are ranked as warm (60.54%), cold (24.16%), hot (8.72%) and cool (6.49%); the main meridians are spleen, lung, liver, stomach and kidney. [Conclusions] The basic pathogenesis of DOR is deficiency of qi and blood, mainly due to dysfunction of the spleen, lung, liver, liver, stomach and other organs, and kidney deficiency and spleen deficiency are more common.

Key words Decreased ovarian reserve (DOR), Traditional Chinese Medicine (TCM), Medication analysis, Pathogenesis

1 Introduction

Decreased ovarian reserve (DOR) is associated with a reduced quantity and quality of the retrieved oocytes, usually leading to poor reproductive outcomes which remain a great challenge for assisted reproduction technology (ART)[1]. There is currently no specific method for the treatment of DOR. The treatment usually includes hormone replacement therapy, improved ART treatment plan, egg donation, egg freezing technology, ovarian transplantation, immunotherapy, antioxidant therapy, and psychotherapy,etc.Although some achievements have been made, but no satisfactory results have been obtained[2]. Traditional Chinese medicine (TCM) syndrome differentiation and treatment combined with western medicine can improve clinical efficacy, reduce toxic and side effects, and play the role of "increasing efficiency and reducing toxicity"[3]. The purpose of this study is to analyze the characteristics of TCM prescriptions through statistical analysis of the TCM prescriptions of DOR in Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, so as to analyze the thinking of prescription and drug use of TCM for the treatment of DOR, to explore the countermeasures of TCM for the treatment of DOR, and accordingly to bring into play and inherit the advantages of TCM treatment.

2 Materials and methods

2.1 General dataWe selected 107 patients diagnosed as DOR and admitted from December 2019 to December 2021 in the second department of gynecology of Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, 47 patients<30 years old, and 60 patients≥30 years old.

2.2 Inclusion and exclusion criteria[4]

2.2.1Inclusion criteria: (i) the pathological screening of Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, B-ultrasonic test excludes diseases of fallopian tube and ovulatory dysfunction; (ii) no abnormality is found in the semen examination index of spouse; (iii) the general information is complete.

2.2.2Exclusion criteria: (i) patients combined with cardiovascular and cerebrovascular or other organ function diseases, not cooperate with this study; (ii) patients combined with other endocrine diseases, body inflammation caused by fever or other diseases; (iii) patients with polycystic ovaries or who have undergone oophorectomy.

2.3 Research methodsWe screened cases according to the inclusion criteria, took consideration of the patients’ prescriptions of TCM, and used Excel software to organize and summarize the prescriptions of all prescriptions, and discussed medication rules. The Chinese medicine names of all prescriptions were normalized with reference to the content ofChinesePharmacy[5], and the classification, properties, flavors, and meridians were standardized according to this standard.

3 Results and analysis

3.1 Comparison of serum sex hormone levels before and after treatmentBefore treatment and after 1 course of treatment (3 menstrual cycles), we tested the patients’ serum-related hormones. We took 5 mL of morning fasting cubital venous blood from patients, followed by centrifugation for 15 min (3 000 r/min) to isolate the serum. Then, we used ELISA to detect serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and Anti-Mullerian hormone (AMH)[6]. The FSH, LH, E2, and AMH kits were purchased from Shanghai Lanpai Biotechnology Co., Ltd., China, and all experiments were done according to the protocols of the kits. Compared with that before treatment, serum sex hormone indexes FSH, LH and FSH/LH were significantly decreased (P<0.05 orP<0.01), AMH was significantly increased (P<0.05 orP<0.01), while E2and INHB showed an increasing trend, but there was no statistical difference (Table 1).

Table 1 Comparison of serum sex hormone levels before and after treatment n=107)

3.2 Analysis of syndrome differentiationWe sorted out and counted the clinical syndrome classification of DOR (Table 2).

Table 2 Statistics of DOR-related TCM syndrome differentiation

3.3 The use of traditional Chinese medicineIn this study, we included a total of 107 patients and used a total of 189 traditional Chinese medicines, with a total frequency of 4 345 drugs and a total of 535 prescriptions. The top five frequency of drug use were: Paeoniae Radix Alba 2 261 times (50.04%), Corni Fructus 2 037 times (46.88%), Rehmanniae Radix Praeparata 1 818 times (41.84%), Testudinis Carapax Et Plastrum 1 610 times (37.05%), and Uncariae Ramulus Cum Uncis 1 303 times (29.99%) (Table 3).

3.4 Classification of drugsDeficiency-tonifying drugs were used most frequently, accounting for 50.64%; heat-clearing drugs and qi-tonifying and blood-tonifying drugs accounted for 19.24% and 17.39%, respectively, and others accounted for 12.73% (Table 4).

Table 3 Analysis of the top five drug users

Table 4 Analysis of drug classification

3.5 Analysis of drug properties and tastesThe top 3 medicinal flavors (tastes) were sweet, acrid, and bitter, of which the cumulative use frequency of sweet drugs was 52.02%, the frequency of acrid drugs was 20.71%, and the cumulative frequency of bitter drugs was 20.32% (Table 5). The medicinal properties were ranked as warm, cold, hot, and cool, and the frequency of use was 60.54%, 24.16%, 8.72%, and 6.49%, respectively (Table 6).

Table 5 Flavor analysis

Table 6 Analysis of drug properties

3.6 Channel tropism of TCMA total of 12 meridians including the spleen, lung, liver, stomach, and kidney meridians were involved in the data, and the frequencies of the first three were 23.34%, 17.16%, and 12.34%, respectively (Table 7).

Table 7 Analysis of drugs returning to meridian

4 Discussion

In TCM, the DOR belongs to the categories of "irregular menstruation", "amenorrhea", "infertility" and "dirty". The medical understanding of the DOR is based on the theory of TCM, the experience of modern clinicians, and animal experiments of TCM[7]. The results are the same as the that of the analysis of the characteristics of TCM treatment of DOR patients in Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine in this paper.

By studying the classification of TCM of DOR patients, it was found that the most frequently used medicines were tonifying deficiency medicines, accounting for 51.40%. TCM has also been used to treat DOR for a long time. From TCM perspective, Kidney qi dominates female reproductive abilities, and blood is the basis of female physiology. Kidney deficiency and blood stasis are considered as the basic pathogenesis of the DOR. Therefore, the traditional medicine method of nourishing kidney is widely applied to treat the DOR[8].

As the core content of the theory of medicinal properties, the four natures and five flavors, and meridians of TCM are one of the important theories of traditional Chinese medicine, and they have a non-negligible effect on the accuracy of drug use[9]. In this analysis, it was found that the medicinal properties of the used drugs were mostly warm and cold, which also reflected the essence of DOR deficiency. The medicinal taste is mainly sweet, bitter and acrid. Sweet can tonify deficiency, bitter can reduce discharge, pungent can disperse, warm can help yang, and cold can clear heat. Liver-cold can invigorate deficiency and heat, smooth and invigorate kidney-essence, and make the kidney absorb essence powerfully, while sweet-warming can invigorate the kidney and help yang. According to the meridian, the spleen, lung, liver and kidney are the main features. The main feature of DOR disease is deficiency of the main body, deficiency of the spleen and kidney, and deficiency of both qi, blood, yin and yang in the late stage[10].

In this study, we explored the prescription and medication ideas of TCM in the treatment of DOR disease, and provided countermeasures for clinical treatment, to give full play to the advantages of TCM. By collecting the TCM prescriptions of 107 patients with DOR in Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, we analyzed the medication rules of TCM in the treatment of DOR disease, summarized the treatment experience, and also strengthened the confidence and ideas of prescription and medication for clinical medication.