针药结合对围绝经期综合征疗效及生存质量的影响
|
摘要
研究背景
围绝经期综合征是妇女在绝经前后由于雌激素水平波动或下降所致的以植物神经系统功能紊乱为主,伴有神经心理症状的一组症候群。临床表现为烘热汗出、心烦易怒、心慌心跳、手足心热、头痛头晕、耳鸣、失眠、精神抑郁、焦虑不安等。这些症状为众多围绝经期妇女带来了困扰,严重影响地她们的生活质量。2009年香港年龄介乎4055岁女性人口已高达一百万人口,随着人口老化香港会有越来越多踏进围绝经期妇女人口,也意味着有更多围绝经期妇女受到该病的困扰,对相关医疗服务需求增加。随着社会健康水平知识的提高,新一代的香港围绝经期妇女更注重健康,追求更卓越的生活质量。由于围绝经期综合征临床症状繁多,病情反复,患病时间长,对广大患者做成严重的身心压力,同时也削弱她们的生产工作能力,令到她们的家庭关系及社交生活受到不良的影响。围绝经期妇女健康是一个不容忽视的大课题,有需要研究关注。由于治疗女性围绝经期综合征所用的西药存在一定的副作用,再加上医学模式的转变、健康概念有了新的内涵,人们不仅追求生命的量更注重生命的质,因此,寻找一种安全,有效的方法对防治本病具有重要的意义。中医是具有数千年实践的医学,中医治疗妇科疾病具有一定的疗效与特色,针灸和中药疗法治疗本病不仅具有较好的临床效果,且毒副作用少、简便易行。如何应用中医优势为围绝经期妇女提供符合需要的中医顾护调治保健措施,加强中医在本港医疗体系中为围绝期妇女健康做出贡献,突出中医防治疾病的优势,以提高广大香港围绝经期妇女的健康质素和生活质量,助她们轻松跨越围绝经期是很值得研究的课题
目的
本课题通过观察针刺结合补肾疏肝中药疗法治疗围绝经期综合征的临床疗效,并比较针刺加中药和纯中药两组不同治疗方法的效果,以及对围绝经期综合征患者生存质量的影响,来探讨针灸治疗围绝经期综合征的可能作用机理。期望通过本次研究,能为日后临床治疗该病提供一项安全有效又具中医特色的疗法,继而为提高众多香港围绝经期综合征患者生存质量做出贡献,并为推动香港中医专科化发展及弘扬中医文化做出贡献。
方法
收集博爱医院中医门诊2010年4月-2010年12月期间就诊,年龄在45-55岁之间的妇女,确诊为围绝经期综合征及符合中医肾虚肝郁证型的诊断的患者共63例为研究对象,按随机化原则,根据随机数字表将符合纳入标准的63例围绝经期综合征患者分为治疗组(针刺加中药组)31例,对照组(单纯中药组)32例。各组具体研究方法分别为：
一、治疗组：采用针刺加补肾疏肝中药治疗。针刺取两组穴位：①：百会、关元、气海、三阴交(双)、太冲(双)；②：肝俞(双)、肾俞(双)、阳陵泉(双)、内关(双)、太溪(双)。操作方法：每次选一组穴位,两组穴位交替使用,下针后每10分钟行针1次,留针30分钟。两组穴位交替使用,隔天一次,月经期间停针灸治疗,连续治疗两个月。
中药：对患者予以浓缩中药颗粒六味地黄丸合丹栀逍遥散(每10克六味地黄丸浓缩中药颗粒含生草药：熟地24g、淮山12g、山萸肉12g、茯苓9g、泽泻9g、牡丹皮9g；每10克丹栀逍遥散浓缩中药颗粒含生草药：柴胡12g、白术12g、当归12g、白芍12g、茯苓12g、牡丹皮10g、栀子10g、炙甘草6g。比例：六味地黄丸：丹栀逍遥散1：1,每天口服2次,每次10克(5克六味地黄丸合5克丹栀逍遥散),连续服用两个月。
二、对照组：采用单纯补肾疏肝中药治疗,对患者予以浓缩中药颗粒六味地黄丸合丹栀逍遥散。比例：六味地黄丸：丹栀逍遥散1：1,每天口服2次,每次10克(5克六味地黄丸合5克丹栀逍遥散),连续服用两个月。
两组治疗前后均从以下几个方面进行临床观察：(1)临床症状评分采用改良Kupperman评分量表,该量表自发表至今是目前国内外应用最广泛的围绝经综合征疗效评价指标,量表里的13个症状可反映与围绝经综合征相关的不同系统的表现,具有一定的代表性。(2)围绝经期综合征主要症状改变测定：对围绝经期综合征常见的主要症状潮热出汗、感觉异常、失眠、易激动、抑郁、眩晕、疲乏、骨关节痛,骨肉痛、头痛、心悸、皮肤蚂蚁走感、性交痛、泌尿系等13项症状,采用改良Kupperman评分表,在治疗前,中(治后1个月),治疗后(治后2个月)各评估1次,并计算其改善值,KI改善值。(3)SF-36健康调查简表(中文版),该量表广泛使用于临床,有较好的信度、效度和代表性,作为生存质量的主要结局指标。其中共有躯体健康(PF)、体角色功能(RP)、躯体疼痛(BP)、总体健康(GH)、活力(VT)、社会功能(SF)、情绪角色功能(RE)、心理健康(MH)等8个维度,每个维度包含若干问题,共36个项目。(4)安全性检测,治疗前后检查血、尿常规、肝肾功能、心电图等,并于治疗期间记录不良反应观察表,疗程结束后填写安全性评价表。两组患者治疗前,治疗1月后及治疗2月后进行均进行问卷评分。将全部数据输入SPSS13.0统计软件,对数据资料进行统计学处理及分析,得出结论。
结果
在实验过程中治疗组和对照均无失访或退出病例,具体治疗结果如下：
一、治疗前两组患者在年龄、病程、中医证型方面等各项基本资料组间比较,经独立样本T检验后(P>0.05)无统计学差异,提示两组样本均来自于同一总体,彼此间具有可比性。
二、围绝经期综合征临床症状疗效评价
(1)改良Kupperman(KI)评分
治疗前两组间总体症状总评分KI指数比较无差异(P>0.05),表明两组间基本资料具有可比性。①治疗后1个月及2个月治疗组KI指数自身前后比较有显著性差异(P<0.01),治疗后1个月及2个月对照组KI指数自身前后比较有显著性差异(P<0.01),提示两组治疗方法都有效,证明两组治疗方法都能大幅度降低了KI评分,有效治疗围绝经期综合征症状如潮热出汗、感觉异常、失眠、易激动、抑郁、眩晕、疲乏、骨关节痛、骨肉痛、头痛、心悸、皮肤蚂蚁走感、性交痛、泌尿系等症状,而且治疗两个月的效果明显比治疗一个月的效果好。②治后两组间KI指数改善值比较有差异(P<0.05),说明治疗组针刺加中药整体的效果比对照组单纯中药好。③治疗前两组的KI评分均值都接近25分,在治疗后1个月,治疗组KI指数均值由治疗前的25.90±6.91下降至治疗后的15.52±5.09；对照组KI指数均值由治疗前的24.25±6.21下降至治疗后的15.69±4.41；结果显示两组的KI指数都大幅度下降,证明两种治疗方法都可以有效改善患者肾虚肝郁体质所导致的围绝经期综合征症状。连续治疗2个月后,两组的KI指数持续下降,提示连续治疗两个月有加强疗效的作用。治疗组的KI改善值与对照组比较有显著差异,证明针药结合治疗比单纯中药疗效好。提示治疗组针药结合疗效明显优于对照纯中药组,针刺结合中药方对治疗围绝经期综合征疗效确切。
(2)两组间各项围绝经期综合征症状组间疗效比较评价
围绝经期综合征各症状疗效分析得出以下结论：①治疗组、对照组两组内比较：治疗1个月和治疗2个月在改善各个症状上两组均有效(P<0.05)。②治疗组、对照组两组组间比较：两组在治疗1个月和治疗2个月后KI改善值均比较无差异的症状为：潮热汗出、疲乏和性交痛症状；两组在治疗1个月和治疗2个月后KI改善值均比较有差异的症状为：失眠、易激动、抑郁、眩晕、骨关节、骨肉痛、头痛、心悸、皮肤蚂蚁样走感和泌尿系症状,说明治疗组的针刺加中药比对照组的纯中药治疗在神经系统,心理及疼痛症状上效果好；治疗1个月后,KI改善值均比较有差异的为：感觉异常(P=0.016),说明两组组间比较在改善感觉异常治疗组见效较快,但是治疗2个月后效果相若,提示中药的疗效起效较慢。
三、治疗前后两组生存质量比较
治疗前两组间相比,SF—36健康调查简表评分在8个维度上均无明显差异(P>0.05),说明两组之间具有可比性。①治疗组经治疗后在8个维度上均有明显改善(P<0.01),且在综合积分方面也有明显提高(P<0.01),说明针刺加中药治疗能有效改善其生存质量；②对照组经治疗后在8个维度上均有明显改善(P<0.01),且在综合积分方面也有明显提高(P<0.01),说明补肾疏肝法的中药治疗能有效改善其生存质量。③治疗后治两组间比较,除了在躯体健康(PF)、体角色功能(RP)、心理健康(MH)三方面治疗组与对照组无明显差异(P>0.05)外,在躯体疼痛(BP)、总体健康(GH)、生命活力(VT)、情绪角色功能(RE)及综合积分等方面,两组间比较,结果在统计学上均有显著性差异(P<0.01)。社会功能(SF)两组间比较,结果在统计学上有差异(P<0.05)。④表18结果显示运用针刺结加中药疗法的治疗组,在改善患者生存质量,如躯体疼痛(BP)、总体健康(GH)、生命活力(VT)、情绪角色功能(RE)、社会功能(SF)等五方面的作用,其疗效更优于采用单纯中药组；但两组在改善两躯体健康(PF)、体角色功能(RP)、心理健康(MH)三方面,组间的程度并无明显差异,说明两组在改善这三方面的疗效相若。
四、治疗后两组疗效比较
两组患者疗效构成比组间比较,经Ridit分析后两组间疗效比较有差异(P<0.05)。说明运用针刺结合中药治疗围绝经期综合征患者,其疗效明显优于采用单纯中药治疗方法。治疗组总有效率为90.3%,而对照组总有效率为75.0%,两组间总疗效比较,统计结果显示,两组间比较无差异(P>0.05),说明运用针刺结合中药治疗围绝经期综合征患者,其总体疗效与采用单纯中药治疗效果相若。
五、治疗后两组不良反应比较
整个研究过程中,治疗期间,治疗组与对照组中的患者均未发现明显不良反应,故两组安全级别均属于1级。结论
临床证实针刺能刺激输穴通过经络的传导调节脏腑功能,使得全身各大系统的功能得到调整,改善神经功能,镇静、镇痛等使临床症状得到有效的控制和改善,患者躯体疼痛症状减轻、生活和工作能力、情绪稳定、社会功能增强、总体健康水平显著提高。补肾疏肝中药治疗本病切中病机,六味地黄丸及丹桅逍遥散合方对机体的作用是多方面、多系统、多靶点的,从而对肾虚肝郁型围绝经期综合征所导致的一系列烦躁易怒、头晕耳鸣、口干目涩、潮热汗出、口干口苦、心烦失眠等症状起良好的治疗效果。因此针药结合治疗围绝经期综合征疗效优于单纯中药治疗,值得在临床中推广使用。
Background
Climacteric syndrome in premenopausal and postmenopausal women, estrogen level fluctuates or falls dramatically lead to autonomic nervous system dysfunction, neuropsychological symptoms associated with a group of syndromes. Clinical manifestations are hot flashes and sweating, upset, irritability, heart palpitation, dyshoria heat, headache, dizziness, tinnitus, insomnia, depression, anxiety and so on. These symptoms bring serious impact to their quality of life affect their health.2009 Hong Kong female population aged 40-55 years has been as high as one million, as the population group grows there will be more and more women suffering from the disease and increase demand for related medical services. With the improvement of community health knowledge, the new generation of Hong Kong perimenopausal women pay more attention to health and to pursuit superior quality of life. Because the vast clinical symptoms of climacteric syndrome, repeated illness, illness for a long time, the majority of patients caused serious physical and mental pressure, but also undermine the work of their productivities so that their family relationships and social lives have been adversely affected. Perimenopausal women's health is a major issue can not be ignored, it is a beam subject worth to study. Because the treatment of female climacteric syndrome by western medicine cause certain side effects, coupled with the medical model of change, the new concept of health, the amount of people not only pay more attention to the pursuit of life, but also the quality of life. Therefore, to find a safe and effective method for the prevention and treatment of this disease has important practical significance. Chinese medicine had been practiced for thousands of years, Chinese medicine treatment of gynecological diseases has unique characteristics and good clinical effects, acupuncture and Chinese medicine therapies to treat the disease not only has better clinical effect, but also with fewer side effects, and in a easier way. How to take the advantages of Chinese medicine for the application on the treatment for perimenopausal syndromes, to strengthen the role of Chinese medicine in Hong Kong health care system to contribute to women's health, to highlight the advantages of Chinese medicine on disease controlling for the improvement of the perimenopausal women's heath in the quality and quality of life, to help them easily across the perimenopause is a very interesting topic.
Objective
To observe acupuncture combined with Chinese medicine treatment for the type of kidney deficiency and stagnation in liver Qi perimenopausal syndrome clinical efficacy, and to compare of acupuncture combined with Chinese medicine treatment with pure Chinese medicine treatment, and the effects of two different treatment modalities, and perimenopausal syndrome patients on quality of life, to further explore the acupuncture treatment mechanism on perimenopausal syndrome. Hope that through this study, to find a safe and effective clinical treatment measures for curing the disease in the future, but also with Chinese characteristics therapies, and then to improve the patients'quality of life with perimenopausal syndrome in Hong Kong, to contribute and to promote traditional Chinese medicine development in Hong Kong and promote Chinese medical specialty to contribute to traditional Chinese medical industry.
Methods
Collection of Pok Oi Hospital Chinese Medicine Clinic patients during the period of April -December 2010, whose ages between 45-55 years old, diagnosed as perimenopausal syndrome and kidney deficiency and stagnation in liver Qi type consistent with traditional Chinese medicine diagnosis, with a total of 63 cases studied, according to the principle of randomization, according to random number table to meet the inclusion criteria of the 63 cases of perimenopausal syndrome were divided into treatment group (acupuncture combined with traditional Chinese medicine group) 31 patients, in the control group (treated with traditional Chinese medicine) were 32 patients. Specific research methods of each group are:
1.The treatment group(Acupuncture combined with Chinese medicine treatment):
Acupuncture:Take two sets of acupuncture points:①:Baihui, Guanyuan, Qihai, Sanyinjiao (double), Taichong (double);②:Ganshu (double), Shen shu (double), Yanglingquan (double), Neiguan (double), Taixi (double). Methods of operation:each time take a group of selected points, two groups are used interchangeably. Needling every 10 minutes, let the needles stay for 30 minutes. Alternate use of two sets of points, every other day, stops acupuncture treatment during menstruation period, continuous treatment for two months.
Chinese medicine:Gives the patients concentrated Chinese medicine powder which is made up of Liu Wei Di Huang Wan and Dan Zhi Xiao Yao San (10 grams of concentrated Liu Wei Di Huang Wan powder containing Chinese medicinal herbs: Rehmannia 24g, Chinese yam 12g, Cornus 12g, Poria 9g, Alisma 9g, Cortex Moutan 9g; 10 grams of concentrated Dan Zhi Xiao Yao San powder containing Chinese medicinal herbs:Radix Bupleuri 12g, Atractylodes 12g, Angelica 12g, White Peony Root 12g, Poria 12g, Cortex Moutan 10g, Gardenia 10g, Baked Licorice 6g. Ratio:Liu Wei Di Huang Wan:Danzhi Xiao Yao San 1:1,2 times a day orally, each time 10 grams (5 grams Liu Wei Di Huang mixed with 5 grams Dan Xiao Yao San), Continuous taking for two months.
2. The control group (Chinese medicine treament):Gives the patients concentrated Chinese medicine powder which is made up of Liu Wei Di Huang Wan and Dan Zhi Xiao Yao San. Ratio:Liu Wei Di Huang Wan:Dan Zhi Xiao Yao San 1:1,2 times a day orally, each timelO grams (5 grams Liu Wei Di Huang mixed with 5 grams Dan Xiao Yao San), Continuous taking for two months.
Before and after treatment in both groups from the clinical observation of the following aspects:(1) clinical symptom score using the modified Kupperman score scale, the scale is most extensive used for the evaluation of perimenopausal syndrome, the scale reflects the 13 symptoms associated with menopause syndrome, the performance of different systems, with a certain representation. (2) Determination of the main symptoms of perimenopausal syndrome changes:hot flushes and sweating, paresthesia, insomnia, irritability, depression, dizziness, fatigue, bone and joint pain, muscle pain, headache, heart palpitation, feeling of ants crawling skin, the sense of painful intercourse, urinary symptoms, take assessments by using the modified Kupperman score scale, in the treatment before, during (1 month after treatment)and after treatment (2 months after treatment), and calculate the value of its improvements, calculate the KI improvement value. (3) MOS SF-36 Health Survey (Chinese version), which are widely used in clinical scale has good reliability, validity and representativeness of the main outcomes as quality of life indicators. Among them, physical health (PF), physical role function (RP), bodily pain (BP), general health (GH), vitality (VT), social function (SF), emotional role functioning (RE), mental health (MH),8 dimensions, each dimension contains a number of issues, a total of 36 items. (4) Safety testing:before and after the treatment examine blood, urine, liver and kidney function, ECG, etc., and the adverse reactions observed during the treatment will be recorded, safety course evaluation form will be completed after treatment. Two groups of patients before treatment,1 month and 2 months after treatment were carried out a questionnaire rating. All data entry into computer and the SPSS13.0 the statistical software is used for data processing and analysis of statistical data, draw conclusions.
Results
During the experiment, there has no lost or out of the control cases, specific treatment results were as follows:
1. Before treatment two groups of patients in age, duration and other aspects of syndromes between the two groups of basic information, after examination by Riddit-test (P> 0.05) no significant difference, suggesting that two sets of samples from the same population, had a good comparability between.
2.The clinical symptoms of perimenopausal syndrome efficacy evaluation
(1) modified Kupperman (KI) score
Before treatment, the overall total score clinical symptoms between the two groups showed no difference between KI index (P>0.05), shows that basic information between the two groups were comparable.①After 1 month and 2 months treatment, the comparison of treatment group KI index of its own before and after, there was significant difference (P<0.01), after 1 month and 2 months treatment, the comparison of control group KI index of its own before and after, there was significant difference (P<0.01), suggesting that two treatment methods are effective, proven both methods can substantially reduce the KI score, effective relieving the symptoms of menopausal syndrome such as hot flashed and sweating, paresthesia, insomnia, irritability, depression, dizziness, Fatigue, bone and joint pain, muscle pain, headache, heart palpitation, feeling of ants crawling skin, the sense of painful intercourse, urinary symptoms, and treatment effects of two months was significantly better than the effect of one month treatment.②Comparison between the two groups after treatment, the improvement value of KI index were significantly different (P<0.05), proofing that the treatment group effect of acupuncture combined with Chinese medicine as a whole better than the control group with pure Chinese medicine.③Before treatment, the mean KI score in both groups are closed to 25 points,1 month after treatment, the treatment group mean KI index score dropped from 25.90±6.91 to 15.52±5.09; the control group mean KI index score dropped from 24.25±6.21 to 15.69±4.41; The results shown that the KI index of the two groups are significant decline in two treatment methods can prove effective in improving physical fitness in patients with the type of kidney deficiency and liver Qi stagnation perimenopausal syndrome symptoms. Treatment for 2 consecutive months, the two groups KI index continued to decline, suggesting that there is continuous treatment effect for two months to strengthen the role of efficacy.The comparison of KI to improvement value between two groups shown significant differences, proving that acupuncture combined with Chinese medicine treatment is effective than pure Chinese medicine treatment. Acupuncture combined with prompt treatment group were significantly better than pure Chinese medicine, acupuncture combined with Chinese medicine to treat perimenopausal syndrome is more effective.
(2) Symptoms Comparative evaluation of efficacy between the two groups Clinical analysis of the symptoms come to the following summary:①treatment group and control group compared within groups:1 month treatment and 2 months treatment of various symptoms in both groups shown effective improvement (P <0.05).②treatment group and control group comparison between two groups: 1 month treatment and 2 months treatment the value of KI improvement were no difference in symptoms:hot flashes and sweating, fatigue, the sense of painful intercourse; the value of KI improvement comparison between groups shown significant difference in those symptoms:insomnia, irritability, depression, dizziness, bone and joint pain, muscle pain, headache, heart palpitation, feeling of ants crawling skin, urinary symptoms, indicating that the treatment group has a better curing effect than the control group in the nervous system, psychological and pain symptoms.1 month after treatment, KI improvement values comparison shown difference in two groups in paresthesia symptom (P=0.016), proving that the treated group had a more rapid and effective effect in relieving that symptom, but the treatment effect is almost the same after 2 months treatment in both groups, suggesting a slower onset of efficacy of traditional Chinese medicine.
1. The comparison of the quality of life before and after treatment between two groups
Before treatments, comparison between the two groups, SF-36 Health Survey score in 8 dimensions were no significant differences (P> 0.05), shown that they were comparable between groups.①After treatments,8 dimensions were significantly improved (P<0.01), and in terms of comprehensive integration also significantly increased (P<0.01), the curing effect in treatment group(acupuncture combined with Chinese medicine) that can improve their quality of life;②After treatment, in the control group,8 dimensions were significantly improved (P<0.01), and in terms of comprehensive integration also significantly increased (P<0.01), proving that Chinese medicine treatment of nourishing kidney and dredging liver Qi method can effectively improve their quality of life.③governance between two groups after treatment, in addition to physical health (PF), physical role function (RP), mental health (MH) had no significant difference (P>0.05), but in bodily pain (BP), general health (GH), vitality (VT), emotional role functioning (RE) and other aspects of comprehensive integration between two groups, the results were statistically significant differences (P<0.01). Social function (SF) between two groups, resulting in a statistically different (P<0.05).④Table 18 results shown that the use of acupuncture combined with Chinese medicine treatment group, improving patients quality of life in the role of five aspects, such as bodily pain (BP), general health (GH), vitality (VT), emotional role functioning (RE), social function (SF), and its efficacy is better than using pure traditional Chinese medicine group; but two groups in improving physical health (PF), physical role function (RP), mental health (MH), the degree of effectiveness had no significant difference, indicating that two groups in terms of improving those aspects were of similar efficacy.
2. Comparison of effectiveness in two groups after treatment
The constituent ratio of efficacy between the two groups were compared by ridit test after the treatments, shown significant differences (P<0.05), indicating the use of acupuncture combined with Chinese medicine treatment, significantly better than treatment with medicine alone in healing menopausal syndrome patients. The total effective rate was 90.3% in treatment group, while the control group, the total effective rate was 75.0%, total effective comparison between two groups, statistical results showed no significant difference between the two groups (P> 0.05), that confining the use of acupuncture combined with Chinese medicine treatment on menopausal syndrome, its overall efficacy were similar to the effect with pure Chinese medicine treatment group.
5. The comparison of adverse reactions between two groups after treatment
Throughout the study, no significant adverse reactions found in both treatment group and control groups, so the two groups belong to a safety level.
Conclusion
Clinically proven to stimulate acupuncture points through the meridians to regulate organs function, making the body function in a better way, adjusting to improve neurological function, sedation, analgesia, etc. so that effective control of clinical symptoms and improvement in pain and symptom relief in patients with physical, life and working ability, emotional stability, social enhancements, the overall health improved significantly. Chinese medicine treatment, the use of Liu Wei Di Huang Wan with Dan Zhi Xiao Yao San together regulating the body, in multi-system, multi-target way. This Chinese medical formula had good therapeutic effect on the type of kidney deficiency and liver Qi stagnation perimenopausal syndrome which caused a series of irritability, dizziness, tinnitus, dry eyes, hot flashes, and sweating, dry mouth, bittery mouth, upset, insomnia and other symptoms. The clinical results proven the effect of acupuncture combined with Chinese medicine on perimenopausal syndrome was better than that of Chinese medicine alone, it is worth promoting in clinical use.
围绝经期综合征是妇女在绝经前后由于雌激素水平波动或下降所致的以植物神经系统功能紊乱为主,伴有神经心理症状的一组症候群。临床表现为烘热汗出、心烦易怒、心慌心跳、手足心热、头痛头晕、耳鸣、失眠、精神抑郁、焦虑不安等。这些症状为众多围绝经期妇女带来了困扰,严重影响地她们的生活质量。2009年香港年龄介乎4055岁女性人口已高达一百万人口,随着人口老化香港会有越来越多踏进围绝经期妇女人口,也意味着有更多围绝经期妇女受到该病的困扰,对相关医疗服务需求增加。随着社会健康水平知识的提高,新一代的香港围绝经期妇女更注重健康,追求更卓越的生活质量。由于围绝经期综合征临床症状繁多,病情反复,患病时间长,对广大患者做成严重的身心压力,同时也削弱她们的生产工作能力,令到她们的家庭关系及社交生活受到不良的影响。围绝经期妇女健康是一个不容忽视的大课题,有需要研究关注。由于治疗女性围绝经期综合征所用的西药存在一定的副作用,再加上医学模式的转变、健康概念有了新的内涵,人们不仅追求生命的量更注重生命的质,因此,寻找一种安全,有效的方法对防治本病具有重要的意义。中医是具有数千年实践的医学,中医治疗妇科疾病具有一定的疗效与特色,针灸和中药疗法治疗本病不仅具有较好的临床效果,且毒副作用少、简便易行。如何应用中医优势为围绝经期妇女提供符合需要的中医顾护调治保健措施,加强中医在本港医疗体系中为围绝期妇女健康做出贡献,突出中医防治疾病的优势,以提高广大香港围绝经期妇女的健康质素和生活质量,助她们轻松跨越围绝经期是很值得研究的课题
目的
本课题通过观察针刺结合补肾疏肝中药疗法治疗围绝经期综合征的临床疗效,并比较针刺加中药和纯中药两组不同治疗方法的效果,以及对围绝经期综合征患者生存质量的影响,来探讨针灸治疗围绝经期综合征的可能作用机理。期望通过本次研究,能为日后临床治疗该病提供一项安全有效又具中医特色的疗法,继而为提高众多香港围绝经期综合征患者生存质量做出贡献,并为推动香港中医专科化发展及弘扬中医文化做出贡献。
方法
收集博爱医院中医门诊2010年4月-2010年12月期间就诊,年龄在45-55岁之间的妇女,确诊为围绝经期综合征及符合中医肾虚肝郁证型的诊断的患者共63例为研究对象,按随机化原则,根据随机数字表将符合纳入标准的63例围绝经期综合征患者分为治疗组(针刺加中药组)31例,对照组(单纯中药组)32例。各组具体研究方法分别为：
一、治疗组：采用针刺加补肾疏肝中药治疗。针刺取两组穴位：①：百会、关元、气海、三阴交(双)、太冲(双)；②：肝俞(双)、肾俞(双)、阳陵泉(双)、内关(双)、太溪(双)。操作方法：每次选一组穴位,两组穴位交替使用,下针后每10分钟行针1次,留针30分钟。两组穴位交替使用,隔天一次,月经期间停针灸治疗,连续治疗两个月。
中药：对患者予以浓缩中药颗粒六味地黄丸合丹栀逍遥散(每10克六味地黄丸浓缩中药颗粒含生草药：熟地24g、淮山12g、山萸肉12g、茯苓9g、泽泻9g、牡丹皮9g；每10克丹栀逍遥散浓缩中药颗粒含生草药：柴胡12g、白术12g、当归12g、白芍12g、茯苓12g、牡丹皮10g、栀子10g、炙甘草6g。比例：六味地黄丸：丹栀逍遥散1：1,每天口服2次,每次10克(5克六味地黄丸合5克丹栀逍遥散),连续服用两个月。
二、对照组：采用单纯补肾疏肝中药治疗,对患者予以浓缩中药颗粒六味地黄丸合丹栀逍遥散。比例：六味地黄丸：丹栀逍遥散1：1,每天口服2次,每次10克(5克六味地黄丸合5克丹栀逍遥散),连续服用两个月。
两组治疗前后均从以下几个方面进行临床观察：(1)临床症状评分采用改良Kupperman评分量表,该量表自发表至今是目前国内外应用最广泛的围绝经综合征疗效评价指标,量表里的13个症状可反映与围绝经综合征相关的不同系统的表现,具有一定的代表性。(2)围绝经期综合征主要症状改变测定：对围绝经期综合征常见的主要症状潮热出汗、感觉异常、失眠、易激动、抑郁、眩晕、疲乏、骨关节痛,骨肉痛、头痛、心悸、皮肤蚂蚁走感、性交痛、泌尿系等13项症状,采用改良Kupperman评分表,在治疗前,中(治后1个月),治疗后(治后2个月)各评估1次,并计算其改善值,KI改善值。(3)SF-36健康调查简表(中文版),该量表广泛使用于临床,有较好的信度、效度和代表性,作为生存质量的主要结局指标。其中共有躯体健康(PF)、体角色功能(RP)、躯体疼痛(BP)、总体健康(GH)、活力(VT)、社会功能(SF)、情绪角色功能(RE)、心理健康(MH)等8个维度,每个维度包含若干问题,共36个项目。(4)安全性检测,治疗前后检查血、尿常规、肝肾功能、心电图等,并于治疗期间记录不良反应观察表,疗程结束后填写安全性评价表。两组患者治疗前,治疗1月后及治疗2月后进行均进行问卷评分。将全部数据输入SPSS13.0统计软件,对数据资料进行统计学处理及分析,得出结论。
结果
在实验过程中治疗组和对照均无失访或退出病例,具体治疗结果如下：
一、治疗前两组患者在年龄、病程、中医证型方面等各项基本资料组间比较,经独立样本T检验后(P>0.05)无统计学差异,提示两组样本均来自于同一总体,彼此间具有可比性。
二、围绝经期综合征临床症状疗效评价
(1)改良Kupperman(KI)评分
治疗前两组间总体症状总评分KI指数比较无差异(P>0.05),表明两组间基本资料具有可比性。①治疗后1个月及2个月治疗组KI指数自身前后比较有显著性差异(P<0.01),治疗后1个月及2个月对照组KI指数自身前后比较有显著性差异(P<0.01),提示两组治疗方法都有效,证明两组治疗方法都能大幅度降低了KI评分,有效治疗围绝经期综合征症状如潮热出汗、感觉异常、失眠、易激动、抑郁、眩晕、疲乏、骨关节痛、骨肉痛、头痛、心悸、皮肤蚂蚁走感、性交痛、泌尿系等症状,而且治疗两个月的效果明显比治疗一个月的效果好。②治后两组间KI指数改善值比较有差异(P<0.05),说明治疗组针刺加中药整体的效果比对照组单纯中药好。③治疗前两组的KI评分均值都接近25分,在治疗后1个月,治疗组KI指数均值由治疗前的25.90±6.91下降至治疗后的15.52±5.09；对照组KI指数均值由治疗前的24.25±6.21下降至治疗后的15.69±4.41；结果显示两组的KI指数都大幅度下降,证明两种治疗方法都可以有效改善患者肾虚肝郁体质所导致的围绝经期综合征症状。连续治疗2个月后,两组的KI指数持续下降,提示连续治疗两个月有加强疗效的作用。治疗组的KI改善值与对照组比较有显著差异,证明针药结合治疗比单纯中药疗效好。提示治疗组针药结合疗效明显优于对照纯中药组,针刺结合中药方对治疗围绝经期综合征疗效确切。
(2)两组间各项围绝经期综合征症状组间疗效比较评价
围绝经期综合征各症状疗效分析得出以下结论：①治疗组、对照组两组内比较：治疗1个月和治疗2个月在改善各个症状上两组均有效(P<0.05)。②治疗组、对照组两组组间比较：两组在治疗1个月和治疗2个月后KI改善值均比较无差异的症状为：潮热汗出、疲乏和性交痛症状；两组在治疗1个月和治疗2个月后KI改善值均比较有差异的症状为：失眠、易激动、抑郁、眩晕、骨关节、骨肉痛、头痛、心悸、皮肤蚂蚁样走感和泌尿系症状,说明治疗组的针刺加中药比对照组的纯中药治疗在神经系统,心理及疼痛症状上效果好；治疗1个月后,KI改善值均比较有差异的为：感觉异常(P=0.016),说明两组组间比较在改善感觉异常治疗组见效较快,但是治疗2个月后效果相若,提示中药的疗效起效较慢。
三、治疗前后两组生存质量比较
治疗前两组间相比,SF—36健康调查简表评分在8个维度上均无明显差异(P>0.05),说明两组之间具有可比性。①治疗组经治疗后在8个维度上均有明显改善(P<0.01),且在综合积分方面也有明显提高(P<0.01),说明针刺加中药治疗能有效改善其生存质量；②对照组经治疗后在8个维度上均有明显改善(P<0.01),且在综合积分方面也有明显提高(P<0.01),说明补肾疏肝法的中药治疗能有效改善其生存质量。③治疗后治两组间比较,除了在躯体健康(PF)、体角色功能(RP)、心理健康(MH)三方面治疗组与对照组无明显差异(P>0.05)外,在躯体疼痛(BP)、总体健康(GH)、生命活力(VT)、情绪角色功能(RE)及综合积分等方面,两组间比较,结果在统计学上均有显著性差异(P<0.01)。社会功能(SF)两组间比较,结果在统计学上有差异(P<0.05)。④表18结果显示运用针刺结加中药疗法的治疗组,在改善患者生存质量,如躯体疼痛(BP)、总体健康(GH)、生命活力(VT)、情绪角色功能(RE)、社会功能(SF)等五方面的作用,其疗效更优于采用单纯中药组；但两组在改善两躯体健康(PF)、体角色功能(RP)、心理健康(MH)三方面,组间的程度并无明显差异,说明两组在改善这三方面的疗效相若。
四、治疗后两组疗效比较
两组患者疗效构成比组间比较,经Ridit分析后两组间疗效比较有差异(P<0.05)。说明运用针刺结合中药治疗围绝经期综合征患者,其疗效明显优于采用单纯中药治疗方法。治疗组总有效率为90.3%,而对照组总有效率为75.0%,两组间总疗效比较,统计结果显示,两组间比较无差异(P>0.05),说明运用针刺结合中药治疗围绝经期综合征患者,其总体疗效与采用单纯中药治疗效果相若。
五、治疗后两组不良反应比较
整个研究过程中,治疗期间,治疗组与对照组中的患者均未发现明显不良反应,故两组安全级别均属于1级。结论
临床证实针刺能刺激输穴通过经络的传导调节脏腑功能,使得全身各大系统的功能得到调整,改善神经功能,镇静、镇痛等使临床症状得到有效的控制和改善,患者躯体疼痛症状减轻、生活和工作能力、情绪稳定、社会功能增强、总体健康水平显著提高。补肾疏肝中药治疗本病切中病机,六味地黄丸及丹桅逍遥散合方对机体的作用是多方面、多系统、多靶点的,从而对肾虚肝郁型围绝经期综合征所导致的一系列烦躁易怒、头晕耳鸣、口干目涩、潮热汗出、口干口苦、心烦失眠等症状起良好的治疗效果。因此针药结合治疗围绝经期综合征疗效优于单纯中药治疗,值得在临床中推广使用。
Background
Climacteric syndrome in premenopausal and postmenopausal women, estrogen level fluctuates or falls dramatically lead to autonomic nervous system dysfunction, neuropsychological symptoms associated with a group of syndromes. Clinical manifestations are hot flashes and sweating, upset, irritability, heart palpitation, dyshoria heat, headache, dizziness, tinnitus, insomnia, depression, anxiety and so on. These symptoms bring serious impact to their quality of life affect their health.2009 Hong Kong female population aged 40-55 years has been as high as one million, as the population group grows there will be more and more women suffering from the disease and increase demand for related medical services. With the improvement of community health knowledge, the new generation of Hong Kong perimenopausal women pay more attention to health and to pursuit superior quality of life. Because the vast clinical symptoms of climacteric syndrome, repeated illness, illness for a long time, the majority of patients caused serious physical and mental pressure, but also undermine the work of their productivities so that their family relationships and social lives have been adversely affected. Perimenopausal women's health is a major issue can not be ignored, it is a beam subject worth to study. Because the treatment of female climacteric syndrome by western medicine cause certain side effects, coupled with the medical model of change, the new concept of health, the amount of people not only pay more attention to the pursuit of life, but also the quality of life. Therefore, to find a safe and effective method for the prevention and treatment of this disease has important practical significance. Chinese medicine had been practiced for thousands of years, Chinese medicine treatment of gynecological diseases has unique characteristics and good clinical effects, acupuncture and Chinese medicine therapies to treat the disease not only has better clinical effect, but also with fewer side effects, and in a easier way. How to take the advantages of Chinese medicine for the application on the treatment for perimenopausal syndromes, to strengthen the role of Chinese medicine in Hong Kong health care system to contribute to women's health, to highlight the advantages of Chinese medicine on disease controlling for the improvement of the perimenopausal women's heath in the quality and quality of life, to help them easily across the perimenopause is a very interesting topic.
Objective
To observe acupuncture combined with Chinese medicine treatment for the type of kidney deficiency and stagnation in liver Qi perimenopausal syndrome clinical efficacy, and to compare of acupuncture combined with Chinese medicine treatment with pure Chinese medicine treatment, and the effects of two different treatment modalities, and perimenopausal syndrome patients on quality of life, to further explore the acupuncture treatment mechanism on perimenopausal syndrome. Hope that through this study, to find a safe and effective clinical treatment measures for curing the disease in the future, but also with Chinese characteristics therapies, and then to improve the patients'quality of life with perimenopausal syndrome in Hong Kong, to contribute and to promote traditional Chinese medicine development in Hong Kong and promote Chinese medical specialty to contribute to traditional Chinese medical industry.
Methods
Collection of Pok Oi Hospital Chinese Medicine Clinic patients during the period of April -December 2010, whose ages between 45-55 years old, diagnosed as perimenopausal syndrome and kidney deficiency and stagnation in liver Qi type consistent with traditional Chinese medicine diagnosis, with a total of 63 cases studied, according to the principle of randomization, according to random number table to meet the inclusion criteria of the 63 cases of perimenopausal syndrome were divided into treatment group (acupuncture combined with traditional Chinese medicine group) 31 patients, in the control group (treated with traditional Chinese medicine) were 32 patients. Specific research methods of each group are:
1.The treatment group(Acupuncture combined with Chinese medicine treatment):
Acupuncture:Take two sets of acupuncture points:①:Baihui, Guanyuan, Qihai, Sanyinjiao (double), Taichong (double);②:Ganshu (double), Shen shu (double), Yanglingquan (double), Neiguan (double), Taixi (double). Methods of operation:each time take a group of selected points, two groups are used interchangeably. Needling every 10 minutes, let the needles stay for 30 minutes. Alternate use of two sets of points, every other day, stops acupuncture treatment during menstruation period, continuous treatment for two months.
Chinese medicine:Gives the patients concentrated Chinese medicine powder which is made up of Liu Wei Di Huang Wan and Dan Zhi Xiao Yao San (10 grams of concentrated Liu Wei Di Huang Wan powder containing Chinese medicinal herbs: Rehmannia 24g, Chinese yam 12g, Cornus 12g, Poria 9g, Alisma 9g, Cortex Moutan 9g; 10 grams of concentrated Dan Zhi Xiao Yao San powder containing Chinese medicinal herbs:Radix Bupleuri 12g, Atractylodes 12g, Angelica 12g, White Peony Root 12g, Poria 12g, Cortex Moutan 10g, Gardenia 10g, Baked Licorice 6g. Ratio:Liu Wei Di Huang Wan:Danzhi Xiao Yao San 1:1,2 times a day orally, each time 10 grams (5 grams Liu Wei Di Huang mixed with 5 grams Dan Xiao Yao San), Continuous taking for two months.
2. The control group (Chinese medicine treament):Gives the patients concentrated Chinese medicine powder which is made up of Liu Wei Di Huang Wan and Dan Zhi Xiao Yao San. Ratio:Liu Wei Di Huang Wan:Dan Zhi Xiao Yao San 1:1,2 times a day orally, each timelO grams (5 grams Liu Wei Di Huang mixed with 5 grams Dan Xiao Yao San), Continuous taking for two months.
Before and after treatment in both groups from the clinical observation of the following aspects:(1) clinical symptom score using the modified Kupperman score scale, the scale is most extensive used for the evaluation of perimenopausal syndrome, the scale reflects the 13 symptoms associated with menopause syndrome, the performance of different systems, with a certain representation. (2) Determination of the main symptoms of perimenopausal syndrome changes:hot flushes and sweating, paresthesia, insomnia, irritability, depression, dizziness, fatigue, bone and joint pain, muscle pain, headache, heart palpitation, feeling of ants crawling skin, the sense of painful intercourse, urinary symptoms, take assessments by using the modified Kupperman score scale, in the treatment before, during (1 month after treatment)and after treatment (2 months after treatment), and calculate the value of its improvements, calculate the KI improvement value. (3) MOS SF-36 Health Survey (Chinese version), which are widely used in clinical scale has good reliability, validity and representativeness of the main outcomes as quality of life indicators. Among them, physical health (PF), physical role function (RP), bodily pain (BP), general health (GH), vitality (VT), social function (SF), emotional role functioning (RE), mental health (MH),8 dimensions, each dimension contains a number of issues, a total of 36 items. (4) Safety testing:before and after the treatment examine blood, urine, liver and kidney function, ECG, etc., and the adverse reactions observed during the treatment will be recorded, safety course evaluation form will be completed after treatment. Two groups of patients before treatment,1 month and 2 months after treatment were carried out a questionnaire rating. All data entry into computer and the SPSS13.0 the statistical software is used for data processing and analysis of statistical data, draw conclusions.
Results
During the experiment, there has no lost or out of the control cases, specific treatment results were as follows:
1. Before treatment two groups of patients in age, duration and other aspects of syndromes between the two groups of basic information, after examination by Riddit-test (P> 0.05) no significant difference, suggesting that two sets of samples from the same population, had a good comparability between.
2.The clinical symptoms of perimenopausal syndrome efficacy evaluation
(1) modified Kupperman (KI) score
Before treatment, the overall total score clinical symptoms between the two groups showed no difference between KI index (P>0.05), shows that basic information between the two groups were comparable.①After 1 month and 2 months treatment, the comparison of treatment group KI index of its own before and after, there was significant difference (P<0.01), after 1 month and 2 months treatment, the comparison of control group KI index of its own before and after, there was significant difference (P<0.01), suggesting that two treatment methods are effective, proven both methods can substantially reduce the KI score, effective relieving the symptoms of menopausal syndrome such as hot flashed and sweating, paresthesia, insomnia, irritability, depression, dizziness, Fatigue, bone and joint pain, muscle pain, headache, heart palpitation, feeling of ants crawling skin, the sense of painful intercourse, urinary symptoms, and treatment effects of two months was significantly better than the effect of one month treatment.②Comparison between the two groups after treatment, the improvement value of KI index were significantly different (P<0.05), proofing that the treatment group effect of acupuncture combined with Chinese medicine as a whole better than the control group with pure Chinese medicine.③Before treatment, the mean KI score in both groups are closed to 25 points,1 month after treatment, the treatment group mean KI index score dropped from 25.90±6.91 to 15.52±5.09; the control group mean KI index score dropped from 24.25±6.21 to 15.69±4.41; The results shown that the KI index of the two groups are significant decline in two treatment methods can prove effective in improving physical fitness in patients with the type of kidney deficiency and liver Qi stagnation perimenopausal syndrome symptoms. Treatment for 2 consecutive months, the two groups KI index continued to decline, suggesting that there is continuous treatment effect for two months to strengthen the role of efficacy.The comparison of KI to improvement value between two groups shown significant differences, proving that acupuncture combined with Chinese medicine treatment is effective than pure Chinese medicine treatment. Acupuncture combined with prompt treatment group were significantly better than pure Chinese medicine, acupuncture combined with Chinese medicine to treat perimenopausal syndrome is more effective.
(2) Symptoms Comparative evaluation of efficacy between the two groups Clinical analysis of the symptoms come to the following summary:①treatment group and control group compared within groups:1 month treatment and 2 months treatment of various symptoms in both groups shown effective improvement (P <0.05).②treatment group and control group comparison between two groups: 1 month treatment and 2 months treatment the value of KI improvement were no difference in symptoms:hot flashes and sweating, fatigue, the sense of painful intercourse; the value of KI improvement comparison between groups shown significant difference in those symptoms:insomnia, irritability, depression, dizziness, bone and joint pain, muscle pain, headache, heart palpitation, feeling of ants crawling skin, urinary symptoms, indicating that the treatment group has a better curing effect than the control group in the nervous system, psychological and pain symptoms.1 month after treatment, KI improvement values comparison shown difference in two groups in paresthesia symptom (P=0.016), proving that the treated group had a more rapid and effective effect in relieving that symptom, but the treatment effect is almost the same after 2 months treatment in both groups, suggesting a slower onset of efficacy of traditional Chinese medicine.
1. The comparison of the quality of life before and after treatment between two groups
Before treatments, comparison between the two groups, SF-36 Health Survey score in 8 dimensions were no significant differences (P> 0.05), shown that they were comparable between groups.①After treatments,8 dimensions were significantly improved (P<0.01), and in terms of comprehensive integration also significantly increased (P<0.01), the curing effect in treatment group(acupuncture combined with Chinese medicine) that can improve their quality of life;②After treatment, in the control group,8 dimensions were significantly improved (P<0.01), and in terms of comprehensive integration also significantly increased (P<0.01), proving that Chinese medicine treatment of nourishing kidney and dredging liver Qi method can effectively improve their quality of life.③governance between two groups after treatment, in addition to physical health (PF), physical role function (RP), mental health (MH) had no significant difference (P>0.05), but in bodily pain (BP), general health (GH), vitality (VT), emotional role functioning (RE) and other aspects of comprehensive integration between two groups, the results were statistically significant differences (P<0.01). Social function (SF) between two groups, resulting in a statistically different (P<0.05).④Table 18 results shown that the use of acupuncture combined with Chinese medicine treatment group, improving patients quality of life in the role of five aspects, such as bodily pain (BP), general health (GH), vitality (VT), emotional role functioning (RE), social function (SF), and its efficacy is better than using pure traditional Chinese medicine group; but two groups in improving physical health (PF), physical role function (RP), mental health (MH), the degree of effectiveness had no significant difference, indicating that two groups in terms of improving those aspects were of similar efficacy.
2. Comparison of effectiveness in two groups after treatment
The constituent ratio of efficacy between the two groups were compared by ridit test after the treatments, shown significant differences (P<0.05), indicating the use of acupuncture combined with Chinese medicine treatment, significantly better than treatment with medicine alone in healing menopausal syndrome patients. The total effective rate was 90.3% in treatment group, while the control group, the total effective rate was 75.0%, total effective comparison between two groups, statistical results showed no significant difference between the two groups (P> 0.05), that confining the use of acupuncture combined with Chinese medicine treatment on menopausal syndrome, its overall efficacy were similar to the effect with pure Chinese medicine treatment group.
5. The comparison of adverse reactions between two groups after treatment
Throughout the study, no significant adverse reactions found in both treatment group and control groups, so the two groups belong to a safety level.
Conclusion
Clinically proven to stimulate acupuncture points through the meridians to regulate organs function, making the body function in a better way, adjusting to improve neurological function, sedation, analgesia, etc. so that effective control of clinical symptoms and improvement in pain and symptom relief in patients with physical, life and working ability, emotional stability, social enhancements, the overall health improved significantly. Chinese medicine treatment, the use of Liu Wei Di Huang Wan with Dan Zhi Xiao Yao San together regulating the body, in multi-system, multi-target way. This Chinese medical formula had good therapeutic effect on the type of kidney deficiency and liver Qi stagnation perimenopausal syndrome which caused a series of irritability, dizziness, tinnitus, dry eyes, hot flashes, and sweating, dry mouth, bittery mouth, upset, insomnia and other symptoms. The clinical results proven the effect of acupuncture combined with Chinese medicine on perimenopausal syndrome was better than that of Chinese medicine alone, it is worth promoting in clinical use.
引文
[1]刘万成,张滨爽,张丽梅等.针刺对功能失调性子宫出血病人血清激素的影响.中国针灸,1991：11(5)：37.
[2]斐廷辅,宋旭村,王淑云等.针刺对健康育龄女性卵泡早期血浆中雌二醇、孕酮、睾酮含量影响的观察.中国针灸,1998；18(3)：39.
[3]李沛,黄攸玉,王训立,等.针刺对雌性恒河猴生殖内分泌抑制性影响的实验研究.中国针灸,1999：19(8)：486.
[4]陈伯英,程立海,高慧等.针刺对雌性大鼠垂体雌激素受体mRNA表达和血雌二醇水平影响的研究.针刺研究,1998；23(1)：28.
[5]韩济生.美国国立卫生研究院(NIH)举办针灸听证会.中国针灸,1998；18(3)：187.
[6]陈潇,刘德桓.生存质量的研究概述[J].中国当代医学,2006；5(5)：57-59.
[7]张宗芳.从肾论治更年期情志异常.中国医药学报,1996；11(3)：37-38.
[8]罗元恺,郑国平.以补肾为主治疗更年期综合征经验.中国医药学报,1990：5(2)：23.
[9]钱丽旗,姜坤.从肝论治更年期综合征经验.江苏中医,1997；18(8)：5.
[10]何月芬.绝经前后诸症宜从肝论治.新中医,1990；22(1)：1.
[11]薛静燕.健脾升清饮治疗绝经前后诸症62例.南京中医药大学学报,2002：18(3)：186-197.
[12]夏融.更年期综合征侧重心的理论和实践.江苏中医,1996；17(2)：41-43.
[13]谈勇,许小凤,卢苏.绝经前后诸症心肾病机探析.南京中医药大学学报(自然科学版),2001：117(6)：340-342.
[14]王春生.更年期综合征从肺论治.辽宁中医杂志,1989；26(3)：23-24.
[15]汤月萍.夏桂成辨治女性更年期综合征的经验.湖北中医杂志,1997；19(2)：6-7.
[16]李义方,熊超.从肾虚挟瘀论治更年期综合征.吉林中医药,1998；18(3)：29.
[17]傅淑平,张荣华,蔡宇等.从肾虚血瘀论治更年期综合征.陕西中医,2005：26(5)：435.
[18]冯素兰.绝经前后诸症发病机理刍议.内蒙古中医药,1991；10(4)：35.
[19]史爱国,杜朴红.辨证治疗更年期综合征[J].光明中医,1996；13(2)：45.
[20]毛凤仙.更年期综合征与冲任二脉[J].河南中医,1998；18(4)：205.
[21]余庆.脾胃阴火与更年期综合征[J].福建中医学院学报,1999；9(3)：34-3.
[22]张雅萍,陈惠静,王莹威.中药治疗更年期综合征的基础研究进展[J].中医药信息,2001：18(5)：26-29.
[23]夏桂成,陆启滨.更年1号新方治疗更年期综合征120例[J].中国医药学报,1995：10(4)：8.
[24]程化奇,熊舜华,陈友香等.女性更年期综合征阴虚阳亢证与肝郁气滞证宏观辨证与微观辨证研究[J].新中医,1997；29(1)：36.
[25]杜巧林.王小云教授治疗女性更年期综合征经验介绍.新中医杂志,2007；30(10)：11-12.
[26]陈名道,杨颖.绝经妇女激素替代治疗的困境与中医药治疗更年期综合征的前景[J].中西医结合学报,2003；1(1)：9-11.
[27]张桂珍.补肾六法治疗女性更年期综合征[J].福建中医学院学报.2004；14(1)：6-7.
[28]李得萍.更年期综合征辨治体会[J].实用中医药杂志,2002；9：34-35.
[29]陈晓明.分型辨治更年期综合征126例[J].甘肃中医学院学报,1998；15(3)：30.
[30]李艳菊.女性更年期综合征从瘀辨治的体会[J].中国中医药信息杂志,2007；7 (9)：74.
[31]王克俭.补肾法治疗经断前后诸症38例[J].上海中医药杂志,2002；21(8)：31-32.
[32]肖高秀,彭国强.六味地黄汤加味治疗更年期综合征56例[J].实用中医内科杂志,2004：18(1)：61.
[33]梅肖艳.更年饮治疗女子更年期综合征临床体会[J].实用中西医结合临床,2004：4(5：25.
[34]杨晓红.补肾化瘀汤治疗更年期综合征60例[J].现代中西医结合杂志,200312(20)：2218-2219.
[35]江伟华.加减血府逐瘀汤治疗更年期综合征121例[J].中国中医药信息杂志,2002：9(10)：52.
[36]于智敏.女士更年期综合征治疗的中成药合理运用[J].中药医刊,1997；33(8：10.
[37]阮祥燕,季颖,熊晓燕等.更年宁心胶囊治疗更年期综合征30例[J].中医杂志,2003；44(6)：472.
[38]黎烈荣,谭异伦,范红霞.更年安怡片治疗更年期综合征的临床观察[J].中国中西医结合杂志,1999：19(4)：235-236.
[39]张道武,郑秀芝,王秋景.针灸治疗更年期综合征临床研究.上海针灸杂志,1999：18(4)：20.
[40]陈园秀,赵晓峰.针刺治疗更年期综合征300例临床研究.天津中医学院学报2002：21(2)：20.
[41]李国安,俞吟.针刺治疗女胜更年期综合征的临床研究.上海针灸杂志,2002：21(3)：6.
[42]袁志太.五脏俞加隔俞针刺治疗更年期综合征.上海针灸杂志,1999；18(6)：19.
[43]管建红,马逢升,吴帆等.针刺治疗更年期综合征38例.上海针灸杂志,2000：19(4)：26.
[44]沈晓明,杜元颧,石学敏.从中医脑的学说谈更年期综合征病及针刺立法处方.中医杂志,2002：43(9)：668.
[45]朴联友,孙彩霞,张国瑞.灵龟八法治疗更年期综合征60例小结.北京中医药大学学报,1997：20(3)：44.
[46]孙远征,崔淑子,郭淑颖等.俞募配穴为主治疗更年期综合征.中国针灸,2004：24(2)：85.
[47]李平.耳穴贴压对女性更年期症状及血清内分泌激素的影响.中国临床康复,2005；9(15)：140-141.
[48]杨清芳.耳穴治疗更年期综合征31例.云南中医杂志,1993；14(5)：27.
[49]朱江,郑格林,张水清.耳穴贴压治疗女性更年期综合征59例.上海针灸杂志,1996：15(4)：9.
[50]石秀花,刘品.耳穴压丸治更年期综合征68例体会.江西中医药,1995；26(5)：43.
[51]杨丹红,冯利平.头针结合体针治疗女性更年期忧郁症.浙江中医杂志,1996：31(3)：131.
[52]艾正海.梅花针叩击足部反射区治更年期综合征60例.云南中医中药杂志,1997：18(2)：27.
[53]沈晓明,桂元灏,阎莉等.调神益肾针法治疗更年期综合征35例临床研究[J]. 中医杂志,2003：(44)：347-349.
[54]董军杰.针刺治疗更年期综合征50例疗效观察[J].山西中医,2001；17(1)：42.
[55]王环仁,谢春红等.针刺治疗更年期综合征38例[J].山东省中医杂志,2006：25(7)：468-469.
[56]金慧芳, 金亚蓓.耳针对围绝经期综合征患者Kupperman评分的影响[J].上海针灸杂志,2006：25(12)：6-8.
[57]丁习益.穴位注射治疗更年期综合征31例.上海针灸杂志,2000；19(3)：15.
[58]潘红玲,许天兵.穴位注射治疗更年期综合征临床观察.针灸临床杂志,1998：14(11)：14.
[59]孟进军,穴位注射治疗女性更年期综合征61例疗效观察.湖南中医杂志,1999：15(3)：3.
[60]李芳莉.熏脐灸治疗女性更年期综合征疗效观察[J].针灸临床杂志,2004；20(8)：41-42.
[61]孙良君.灸法治疗更年期功能性子宫出血25例.中国针灸,1996；16(10)：49.
[62]段峻英.穴位埋线治疗更年期综合征68例.上海针灸杂志2005；24(8)：3.
[63]姜守信.穴位埋线治疗女性更年期综合征60例.临床观察.针灸临床杂志,2000：16(7)：46.
[64]李种泰.穴位埋线治疗妇女更年期潮热汗出[J].时珍国医国药,2006；17(12)：2634.
[65]潘文宇,林国华.针刺配合火针治疗更年期综合征103例[J].针灸临床杂志,2005：21(2)：20-21.
[66]孙正军.针药结合治疗妇女更年期综合征42例[J].针灸临床杂志,2006；25(8：18-191.
[67]周军,秦正玉,李伟莉等.电针三阴交治疗围绝经期综合征临床观察[J].中国针灸,2006：26(9)：617-620.
[68]樊瑾, 杨琴华.针灸加磁珠耳压治疗围绝经期综合征31例[J].上海针灸杂志,2006：25(12)：21.
[69]霍则军,张学兵.针灸治疗汗证51例[J].上海针灸杂志,2002；21(4)：33.
[70]Wulf Hu. At last—A new and Precise International Set of menopause-related definitions. Menopause Management,2000;9(1):47.
[71]张宝屏,高晓坚,夏海晖,等.广州地区40-60岁女性社区卫生服务及需求状况的调查分析.中国妇幼保健,1997；12(6)：356.
[72]林守清、林萍、姜玉新等.绝经后卵巢和子宫萎缩及血雌二醇降低的观察.中华妇产科杂志,1997：32(9)：524-527.
[73]杨贵贞.神经-内分泌-免疫调节网络研究之我见.中国免疫学杂志,1990：(2)：120.
[74]李大金.更年期综合征生殖内分泌-免疫功能.上海医学,1996；19(1)：42-44.
[75]廖柏松,胡燕,鞠躬.二仙汤对18月龄雌性大鼠下丘脑-垂体-卵巢轴功能的调节.山东中医学院学报,1996：20(6)：396-398.
[76]冯利,葛嘉峰,孟晓润.坤宁安对去势大鼠血清生殖内分泌的含量影响的实验研究[J].中医药信息,2000：17(4)：63-64.
[77]Greensward DA, Matsumoto AM. Age-regulated decrease in pro-opiomelanocortin (POMC) gene expression in the arcuate nucleus (RAC) of the female rat [J]. Proc Soc Neurosci.,1993; 15:343-351.
[78]陈亚琼,叶雪清.血浆吲哚类神经递质与更年期综合征症状的相关分析[J].中华妇产科杂志,1996：31(1)：41-42.
[79]Stefano GB, Rimura T, Stefano JM, et al. Auto immuno-modulation, age-related opioid differences in vertebrate and invertebrate immune systems [J]. Ann. N. Y. Acad. Sci.,1992; 663:396.
[80]Freedman RR, Krell W. Freedman CS, et al. Reduced thermoregulatory mull zone in postmenopausal women with hot flushes [J]. Am J Obstetric Gynecology,1999;181:66-70.
[81]鲁遂荣,方学温,侯安继等.更年平调液对更年期大鼠自由基影响的实验研究.中国中医基础医学杂志,1998；4(8)：35-37.
[82]张慧,张露芬,李晓泓,等.逆针关元穴对自然更年期大鼠超氧化物歧化酶和一氧化氮合酶活性的调节.中国临床康复,2005；9(31)：147.
[83]许艳丽血清过氧化脂质水平与更年期和性别的关系.老年医学杂志,1992：12(4)：213.
[84]贺漪.更年期综合征女性心理健康水平及影响因素的探讨.实用妇产科杂志, 1997：13(2)：79-81.
[85]18赵更力,徐强.社会文化因素对女性更年期症状影响的研究.中国妇幼保健,2000：15(1)：28-30.
[86]戴为信.绝经后女性激素替代治疗的利与弊.国外医学内科学分册,1998：25(9)：375.
[87]Samsioe G. Introduction to steroids in the menopause. American Journal ofObstetrics and Gynecology,1992;166 (6 Pt 2):1980-1985.
[88]Wiklund l. Holst J, Karlberg J, et al. A new methodological approach to the evaluation of quality of life in postmenopausal women. Maturitas, 1992;14(3):211-224.
[89]程国钧.绝经后女性雌激素替代治疗.中华妇产科杂志,1995；30(2)：123.
[90]林守清.激素补充疗法防治绝经后骨质疏松的进展.实用老年医学1997：11(1)：13.
[91]袁爱敏.尼尔雌醇治疗更年期综合征60例.四川中医,1997；18(3) ：193.
[92]王良岸.倍美力治疗更年期综合征附51例临床分析.广东医学,1996；17(9)：598-600.
[93]陶惠兰.新型性腺激素Livial治疗妇女更年期综合征的临床研究.中国生化药物杂志,1996：17(3)：129-31.
[94]刘风琳.更年期综合征与雌激素替代疗法.北京医学,1997；19(5)：304-306.
[95]C. Azoulay. Menopause in 2004:"hormone replacement therapy" is not what it used to be anymore. C. Azoulay/Larevue de medicine interne, 2004;25:806-815.
[96]高伟,候允天.绝经后激素替代治疗.美国医学会杂志中文版,2004；23(2)：86.
[97]Pollard M, Luckert P H. Influence of isoflavones in soy protein isolates on development of induced prostate-related cancers in L-W rats [J] Nut R C ricer,1997;28 (1):41.
[98]Upmalis D H, Lobo R, Bradley L, et al. Vasomotor symptom for isoflavone extract tablets in postmenopausal women:a multi-centre, double-blind randomized Placebo-controlled study[J]. Menopause,2000;7 (4):236-242.
[99]薛晓鸥,牛建昭,王季峰等.前瞻性对照研究大豆异黄酮治疗绝经期综合征的临床疗效[J].中国中西医结合杂志,2004；24(9)：835-836.
[100]王玉双,张国瑞,刘艳君等.大豆异黄酮对女性围绝经期综合征及性激素的影响[J].中国综合临床,2006；22(1)：86-88.
[101]Ho SC, Wooj, Lams, et al. Soy protein consumption and bone mass in early postmenopausal Chinese women[J]. Osteoporosis Int 2003;14:835-842.
[102]国培,张建伟.更年期妇女的中医保健[M].中医妇科理论与临床,北京：中医古籍出版社,1995：430.
[103]杨惠华.妇女更年期综合征心身护理[J].光明中医,2001：16(96)：18-20.
[104]关继红.有氧运动对女性更年期综合征患者雌激素水平的影响.中华物理医学与康复杂志,2003：25(9)：536-537.
[105]徐侠.更年方结合心理治疗干预治疗女性更年期焦虑患者临床研究[J].辽宁中医杂志,2006：33(3)：303-304.
[106]吴少祯等.常见疾病的诊断与疗效判定标准.中国中医药出版社,1999；10.
[107]国家中医药管理局.中医病证诊断疗效标准.南京：南京大学出版社,1994：66.
[108]国象监督管理局.中华人民共和国标准穴定位,北京：中国标准出版社,1990：8-11.
[109]曹泽毅.中华妇产科学.北京：人民卫生出版社.2002；第1版：2281.
[110]陈伯英,季士珠,高慧.电针促进去卵巢大鼠肾上腺增大,血皮质酮含量升高.针刺研究,1995；20(2)：55.
[111]陈伯英,季士珠,高慧,等.电针对去卵巢大鼠肾上腺核仁组成区蛋白的影响.针刺研究,1994：19(1)：46.
[112]刘宏艳,吴高媛,王滨等.针刺治疗更年期综合征的实验研究.天津中医学院学报,2002；21(1)：45-46
[113]沈晓明,李梦.调神益肾针法对更年期大鼠雌激素效应器官的作用.安徽中医学院学报,2002；21(1)：27-30.
[114]陈伯英,季士珠,高慧等.电针调节大鼠下丘脑一垂体一卵巢轴功能的研究.上海医科大学学报,1994；2(1增刊)：67.
[115]安晓飞,马淑兰,冯异,陈伯英.下丘脑孤啡肽参与电针对去卵巢大鼠LH释放 的影响.针刺研究,2005：30(3)：138.
[116]马晓梵.针刺治疗女性更年期综合征研究山东中医药大学学报1999：23(1)：24.
[117]李沛,黄筱玉,王训立等.针刺对雌恒河猴垂体促性腺激素分泌水平的影响.福建中医学院学报,1997；7(3)：17.
[118]刘小英.六味地黄汤及其去泽泻 茯苓的免疫实验研究 泸州医学院学报,1990；5(3)：207.
[119]陈健安等.六味地黄汤对大鼠下丘脑-垂体性腺轴组织器官形态和性激素的影响.江苏中医,1999；20(3)：46.
[120]周坤福等.六味地黄丸延缓衰老作用机理的实验研究.江苏中医,1999；20(1)：44.
[121]李秀忠.丹桅逍遥散加味治疗更年期综合征105例[J].河南中医,2004：24(12)：62.
[122]韩淑月,沈华.丹桅逍遥散合甘麦大冬汤加减治疗围绝经期综合征80例[J].吉林中医药,2004；24(5)：28.
[123]关丽珍,林继珍.丹桅逍遥散在妇科的临床应用[J].中国医药指南,2008：23(6)：308-310.
[124]WHO. The Development of the WHO Quality of life Assessment Instrument [J]. Geneva, WHO,1993.
[125]韩萍.更年安怡方对更年期综合征患者生活质量影响的初步探讨.中国期刊网优秀博硕士学位论文全文数据库,光盘号：DEZ00303SI.
[126]张磊,黄久仪,范风美等.美国简明健康测量量表与中国老年人生活质量调查表的对比研究.中国行为医学杂志,2001；10(6)：601.
[127]Robert Schleip. Fascial plasticity- a new neurobiological explanation Part1.Journal of Bodywork and Movement Therapies.2003;7(1):11-19.
[128]卓廉士.针灸小白鼠“关元穴”对血浆孕酮及性腺器官的影响.云南中医学院学,1990；(3)：45.
[129]陈贵珍,许云祥,李沛.针刺结合小剂量淫羊蕾对更年期绝经后女性生存质量的改善作用.上海针灸杂志.2005；24(10)：17.
[130]杨廉,路礅,刘媛媛等.温针“肾俞”穴对老年雌鼠子宫、卵巢及性激素作用的研究.针剌研究,2000；25(3)：209.
[131]林志苇,黎健,高丽萍等.肾俞埋线对绝经后骨质疏松症临床疼痛的疗效观察. 针灸临床杂志,2004：20(12)：7.
[2]斐廷辅,宋旭村,王淑云等.针刺对健康育龄女性卵泡早期血浆中雌二醇、孕酮、睾酮含量影响的观察.中国针灸,1998；18(3)：39.
[3]李沛,黄攸玉,王训立,等.针刺对雌性恒河猴生殖内分泌抑制性影响的实验研究.中国针灸,1999：19(8)：486.
[4]陈伯英,程立海,高慧等.针刺对雌性大鼠垂体雌激素受体mRNA表达和血雌二醇水平影响的研究.针刺研究,1998；23(1)：28.
[5]韩济生.美国国立卫生研究院(NIH)举办针灸听证会.中国针灸,1998；18(3)：187.
[6]陈潇,刘德桓.生存质量的研究概述[J].中国当代医学,2006；5(5)：57-59.
[7]张宗芳.从肾论治更年期情志异常.中国医药学报,1996；11(3)：37-38.
[8]罗元恺,郑国平.以补肾为主治疗更年期综合征经验.中国医药学报,1990：5(2)：23.
[9]钱丽旗,姜坤.从肝论治更年期综合征经验.江苏中医,1997；18(8)：5.
[10]何月芬.绝经前后诸症宜从肝论治.新中医,1990；22(1)：1.
[11]薛静燕.健脾升清饮治疗绝经前后诸症62例.南京中医药大学学报,2002：18(3)：186-197.
[12]夏融.更年期综合征侧重心的理论和实践.江苏中医,1996；17(2)：41-43.
[13]谈勇,许小凤,卢苏.绝经前后诸症心肾病机探析.南京中医药大学学报(自然科学版),2001：117(6)：340-342.
[14]王春生.更年期综合征从肺论治.辽宁中医杂志,1989；26(3)：23-24.
[15]汤月萍.夏桂成辨治女性更年期综合征的经验.湖北中医杂志,1997；19(2)：6-7.
[16]李义方,熊超.从肾虚挟瘀论治更年期综合征.吉林中医药,1998；18(3)：29.
[17]傅淑平,张荣华,蔡宇等.从肾虚血瘀论治更年期综合征.陕西中医,2005：26(5)：435.
[18]冯素兰.绝经前后诸症发病机理刍议.内蒙古中医药,1991；10(4)：35.
[19]史爱国,杜朴红.辨证治疗更年期综合征[J].光明中医,1996；13(2)：45.
[20]毛凤仙.更年期综合征与冲任二脉[J].河南中医,1998；18(4)：205.
[21]余庆.脾胃阴火与更年期综合征[J].福建中医学院学报,1999；9(3)：34-3.
[22]张雅萍,陈惠静,王莹威.中药治疗更年期综合征的基础研究进展[J].中医药信息,2001：18(5)：26-29.
[23]夏桂成,陆启滨.更年1号新方治疗更年期综合征120例[J].中国医药学报,1995：10(4)：8.
[24]程化奇,熊舜华,陈友香等.女性更年期综合征阴虚阳亢证与肝郁气滞证宏观辨证与微观辨证研究[J].新中医,1997；29(1)：36.
[25]杜巧林.王小云教授治疗女性更年期综合征经验介绍.新中医杂志,2007；30(10)：11-12.
[26]陈名道,杨颖.绝经妇女激素替代治疗的困境与中医药治疗更年期综合征的前景[J].中西医结合学报,2003；1(1)：9-11.
[27]张桂珍.补肾六法治疗女性更年期综合征[J].福建中医学院学报.2004；14(1)：6-7.
[28]李得萍.更年期综合征辨治体会[J].实用中医药杂志,2002；9：34-35.
[29]陈晓明.分型辨治更年期综合征126例[J].甘肃中医学院学报,1998；15(3)：30.
[30]李艳菊.女性更年期综合征从瘀辨治的体会[J].中国中医药信息杂志,2007；7 (9)：74.
[31]王克俭.补肾法治疗经断前后诸症38例[J].上海中医药杂志,2002；21(8)：31-32.
[32]肖高秀,彭国强.六味地黄汤加味治疗更年期综合征56例[J].实用中医内科杂志,2004：18(1)：61.
[33]梅肖艳.更年饮治疗女子更年期综合征临床体会[J].实用中西医结合临床,2004：4(5：25.
[34]杨晓红.补肾化瘀汤治疗更年期综合征60例[J].现代中西医结合杂志,200312(20)：2218-2219.
[35]江伟华.加减血府逐瘀汤治疗更年期综合征121例[J].中国中医药信息杂志,2002：9(10)：52.
[36]于智敏.女士更年期综合征治疗的中成药合理运用[J].中药医刊,1997；33(8：10.
[37]阮祥燕,季颖,熊晓燕等.更年宁心胶囊治疗更年期综合征30例[J].中医杂志,2003；44(6)：472.
[38]黎烈荣,谭异伦,范红霞.更年安怡片治疗更年期综合征的临床观察[J].中国中西医结合杂志,1999：19(4)：235-236.
[39]张道武,郑秀芝,王秋景.针灸治疗更年期综合征临床研究.上海针灸杂志,1999：18(4)：20.
[40]陈园秀,赵晓峰.针刺治疗更年期综合征300例临床研究.天津中医学院学报2002：21(2)：20.
[41]李国安,俞吟.针刺治疗女胜更年期综合征的临床研究.上海针灸杂志,2002：21(3)：6.
[42]袁志太.五脏俞加隔俞针刺治疗更年期综合征.上海针灸杂志,1999；18(6)：19.
[43]管建红,马逢升,吴帆等.针刺治疗更年期综合征38例.上海针灸杂志,2000：19(4)：26.
[44]沈晓明,杜元颧,石学敏.从中医脑的学说谈更年期综合征病及针刺立法处方.中医杂志,2002：43(9)：668.
[45]朴联友,孙彩霞,张国瑞.灵龟八法治疗更年期综合征60例小结.北京中医药大学学报,1997：20(3)：44.
[46]孙远征,崔淑子,郭淑颖等.俞募配穴为主治疗更年期综合征.中国针灸,2004：24(2)：85.
[47]李平.耳穴贴压对女性更年期症状及血清内分泌激素的影响.中国临床康复,2005；9(15)：140-141.
[48]杨清芳.耳穴治疗更年期综合征31例.云南中医杂志,1993；14(5)：27.
[49]朱江,郑格林,张水清.耳穴贴压治疗女性更年期综合征59例.上海针灸杂志,1996：15(4)：9.
[50]石秀花,刘品.耳穴压丸治更年期综合征68例体会.江西中医药,1995；26(5)：43.
[51]杨丹红,冯利平.头针结合体针治疗女性更年期忧郁症.浙江中医杂志,1996：31(3)：131.
[52]艾正海.梅花针叩击足部反射区治更年期综合征60例.云南中医中药杂志,1997：18(2)：27.
[53]沈晓明,桂元灏,阎莉等.调神益肾针法治疗更年期综合征35例临床研究[J]. 中医杂志,2003：(44)：347-349.
[54]董军杰.针刺治疗更年期综合征50例疗效观察[J].山西中医,2001；17(1)：42.
[55]王环仁,谢春红等.针刺治疗更年期综合征38例[J].山东省中医杂志,2006：25(7)：468-469.
[56]金慧芳, 金亚蓓.耳针对围绝经期综合征患者Kupperman评分的影响[J].上海针灸杂志,2006：25(12)：6-8.
[57]丁习益.穴位注射治疗更年期综合征31例.上海针灸杂志,2000；19(3)：15.
[58]潘红玲,许天兵.穴位注射治疗更年期综合征临床观察.针灸临床杂志,1998：14(11)：14.
[59]孟进军,穴位注射治疗女性更年期综合征61例疗效观察.湖南中医杂志,1999：15(3)：3.
[60]李芳莉.熏脐灸治疗女性更年期综合征疗效观察[J].针灸临床杂志,2004；20(8)：41-42.
[61]孙良君.灸法治疗更年期功能性子宫出血25例.中国针灸,1996；16(10)：49.
[62]段峻英.穴位埋线治疗更年期综合征68例.上海针灸杂志2005；24(8)：3.
[63]姜守信.穴位埋线治疗女性更年期综合征60例.临床观察.针灸临床杂志,2000：16(7)：46.
[64]李种泰.穴位埋线治疗妇女更年期潮热汗出[J].时珍国医国药,2006；17(12)：2634.
[65]潘文宇,林国华.针刺配合火针治疗更年期综合征103例[J].针灸临床杂志,2005：21(2)：20-21.
[66]孙正军.针药结合治疗妇女更年期综合征42例[J].针灸临床杂志,2006；25(8：18-191.
[67]周军,秦正玉,李伟莉等.电针三阴交治疗围绝经期综合征临床观察[J].中国针灸,2006：26(9)：617-620.
[68]樊瑾, 杨琴华.针灸加磁珠耳压治疗围绝经期综合征31例[J].上海针灸杂志,2006：25(12)：21.
[69]霍则军,张学兵.针灸治疗汗证51例[J].上海针灸杂志,2002；21(4)：33.
[70]Wulf Hu. At last—A new and Precise International Set of menopause-related definitions. Menopause Management,2000;9(1):47.
[71]张宝屏,高晓坚,夏海晖,等.广州地区40-60岁女性社区卫生服务及需求状况的调查分析.中国妇幼保健,1997；12(6)：356.
[72]林守清、林萍、姜玉新等.绝经后卵巢和子宫萎缩及血雌二醇降低的观察.中华妇产科杂志,1997：32(9)：524-527.
[73]杨贵贞.神经-内分泌-免疫调节网络研究之我见.中国免疫学杂志,1990：(2)：120.
[74]李大金.更年期综合征生殖内分泌-免疫功能.上海医学,1996；19(1)：42-44.
[75]廖柏松,胡燕,鞠躬.二仙汤对18月龄雌性大鼠下丘脑-垂体-卵巢轴功能的调节.山东中医学院学报,1996：20(6)：396-398.
[76]冯利,葛嘉峰,孟晓润.坤宁安对去势大鼠血清生殖内分泌的含量影响的实验研究[J].中医药信息,2000：17(4)：63-64.
[77]Greensward DA, Matsumoto AM. Age-regulated decrease in pro-opiomelanocortin (POMC) gene expression in the arcuate nucleus (RAC) of the female rat [J]. Proc Soc Neurosci.,1993; 15:343-351.
[78]陈亚琼,叶雪清.血浆吲哚类神经递质与更年期综合征症状的相关分析[J].中华妇产科杂志,1996：31(1)：41-42.
[79]Stefano GB, Rimura T, Stefano JM, et al. Auto immuno-modulation, age-related opioid differences in vertebrate and invertebrate immune systems [J]. Ann. N. Y. Acad. Sci.,1992; 663:396.
[80]Freedman RR, Krell W. Freedman CS, et al. Reduced thermoregulatory mull zone in postmenopausal women with hot flushes [J]. Am J Obstetric Gynecology,1999;181:66-70.
[81]鲁遂荣,方学温,侯安继等.更年平调液对更年期大鼠自由基影响的实验研究.中国中医基础医学杂志,1998；4(8)：35-37.
[82]张慧,张露芬,李晓泓,等.逆针关元穴对自然更年期大鼠超氧化物歧化酶和一氧化氮合酶活性的调节.中国临床康复,2005；9(31)：147.
[83]许艳丽血清过氧化脂质水平与更年期和性别的关系.老年医学杂志,1992：12(4)：213.
[84]贺漪.更年期综合征女性心理健康水平及影响因素的探讨.实用妇产科杂志, 1997：13(2)：79-81.
[85]18赵更力,徐强.社会文化因素对女性更年期症状影响的研究.中国妇幼保健,2000：15(1)：28-30.
[86]戴为信.绝经后女性激素替代治疗的利与弊.国外医学内科学分册,1998：25(9)：375.
[87]Samsioe G. Introduction to steroids in the menopause. American Journal ofObstetrics and Gynecology,1992;166 (6 Pt 2):1980-1985.
[88]Wiklund l. Holst J, Karlberg J, et al. A new methodological approach to the evaluation of quality of life in postmenopausal women. Maturitas, 1992;14(3):211-224.
[89]程国钧.绝经后女性雌激素替代治疗.中华妇产科杂志,1995；30(2)：123.
[90]林守清.激素补充疗法防治绝经后骨质疏松的进展.实用老年医学1997：11(1)：13.
[91]袁爱敏.尼尔雌醇治疗更年期综合征60例.四川中医,1997；18(3) ：193.
[92]王良岸.倍美力治疗更年期综合征附51例临床分析.广东医学,1996；17(9)：598-600.
[93]陶惠兰.新型性腺激素Livial治疗妇女更年期综合征的临床研究.中国生化药物杂志,1996：17(3)：129-31.
[94]刘风琳.更年期综合征与雌激素替代疗法.北京医学,1997；19(5)：304-306.
[95]C. Azoulay. Menopause in 2004:"hormone replacement therapy" is not what it used to be anymore. C. Azoulay/Larevue de medicine interne, 2004;25:806-815.
[96]高伟,候允天.绝经后激素替代治疗.美国医学会杂志中文版,2004；23(2)：86.
[97]Pollard M, Luckert P H. Influence of isoflavones in soy protein isolates on development of induced prostate-related cancers in L-W rats [J] Nut R C ricer,1997;28 (1):41.
[98]Upmalis D H, Lobo R, Bradley L, et al. Vasomotor symptom for isoflavone extract tablets in postmenopausal women:a multi-centre, double-blind randomized Placebo-controlled study[J]. Menopause,2000;7 (4):236-242.
[99]薛晓鸥,牛建昭,王季峰等.前瞻性对照研究大豆异黄酮治疗绝经期综合征的临床疗效[J].中国中西医结合杂志,2004；24(9)：835-836.
[100]王玉双,张国瑞,刘艳君等.大豆异黄酮对女性围绝经期综合征及性激素的影响[J].中国综合临床,2006；22(1)：86-88.
[101]Ho SC, Wooj, Lams, et al. Soy protein consumption and bone mass in early postmenopausal Chinese women[J]. Osteoporosis Int 2003;14:835-842.
[102]国培,张建伟.更年期妇女的中医保健[M].中医妇科理论与临床,北京：中医古籍出版社,1995：430.
[103]杨惠华.妇女更年期综合征心身护理[J].光明中医,2001：16(96)：18-20.
[104]关继红.有氧运动对女性更年期综合征患者雌激素水平的影响.中华物理医学与康复杂志,2003：25(9)：536-537.
[105]徐侠.更年方结合心理治疗干预治疗女性更年期焦虑患者临床研究[J].辽宁中医杂志,2006：33(3)：303-304.
[106]吴少祯等.常见疾病的诊断与疗效判定标准.中国中医药出版社,1999；10.
[107]国家中医药管理局.中医病证诊断疗效标准.南京：南京大学出版社,1994：66.
[108]国象监督管理局.中华人民共和国标准穴定位,北京：中国标准出版社,1990：8-11.
[109]曹泽毅.中华妇产科学.北京：人民卫生出版社.2002；第1版：2281.
[110]陈伯英,季士珠,高慧.电针促进去卵巢大鼠肾上腺增大,血皮质酮含量升高.针刺研究,1995；20(2)：55.
[111]陈伯英,季士珠,高慧,等.电针对去卵巢大鼠肾上腺核仁组成区蛋白的影响.针刺研究,1994：19(1)：46.
[112]刘宏艳,吴高媛,王滨等.针刺治疗更年期综合征的实验研究.天津中医学院学报,2002；21(1)：45-46
[113]沈晓明,李梦.调神益肾针法对更年期大鼠雌激素效应器官的作用.安徽中医学院学报,2002；21(1)：27-30.
[114]陈伯英,季士珠,高慧等.电针调节大鼠下丘脑一垂体一卵巢轴功能的研究.上海医科大学学报,1994；2(1增刊)：67.
[115]安晓飞,马淑兰,冯异,陈伯英.下丘脑孤啡肽参与电针对去卵巢大鼠LH释放 的影响.针刺研究,2005：30(3)：138.
[116]马晓梵.针刺治疗女性更年期综合征研究山东中医药大学学报1999：23(1)：24.
[117]李沛,黄筱玉,王训立等.针刺对雌恒河猴垂体促性腺激素分泌水平的影响.福建中医学院学报,1997；7(3)：17.
[118]刘小英.六味地黄汤及其去泽泻 茯苓的免疫实验研究 泸州医学院学报,1990；5(3)：207.
[119]陈健安等.六味地黄汤对大鼠下丘脑-垂体性腺轴组织器官形态和性激素的影响.江苏中医,1999；20(3)：46.
[120]周坤福等.六味地黄丸延缓衰老作用机理的实验研究.江苏中医,1999；20(1)：44.
[121]李秀忠.丹桅逍遥散加味治疗更年期综合征105例[J].河南中医,2004：24(12)：62.
[122]韩淑月,沈华.丹桅逍遥散合甘麦大冬汤加减治疗围绝经期综合征80例[J].吉林中医药,2004；24(5)：28.
[123]关丽珍,林继珍.丹桅逍遥散在妇科的临床应用[J].中国医药指南,2008：23(6)：308-310.
[124]WHO. The Development of the WHO Quality of life Assessment Instrument [J]. Geneva, WHO,1993.
[125]韩萍.更年安怡方对更年期综合征患者生活质量影响的初步探讨.中国期刊网优秀博硕士学位论文全文数据库,光盘号：DEZ00303SI.
[126]张磊,黄久仪,范风美等.美国简明健康测量量表与中国老年人生活质量调查表的对比研究.中国行为医学杂志,2001；10(6)：601.
[127]Robert Schleip. Fascial plasticity- a new neurobiological explanation Part1.Journal of Bodywork and Movement Therapies.2003;7(1):11-19.
[128]卓廉士.针灸小白鼠“关元穴”对血浆孕酮及性腺器官的影响.云南中医学院学,1990；(3)：45.
[129]陈贵珍,许云祥,李沛.针刺结合小剂量淫羊蕾对更年期绝经后女性生存质量的改善作用.上海针灸杂志.2005；24(10)：17.
[130]杨廉,路礅,刘媛媛等.温针“肾俞”穴对老年雌鼠子宫、卵巢及性激素作用的研究.针剌研究,2000；25(3)：209.
[131]林志苇,黎健,高丽萍等.肾俞埋线对绝经后骨质疏松症临床疼痛的疗效观察. 针灸临床杂志,2004：20(12)：7.